腹腔镜胆囊切除术治疗急、慢性胆囊炎合并胆囊管结石23例

目的 探讨腹腔镜胆囊切除术治疗急、慢性胆囊炎合并胆囊管结石的临床疗效.方法 对23例急、慢性胆囊炎合并胆囊管结石患者均行腹腔镜胆囊切除术.结果 23例患者中,术前B型超声或CT检查诊断为胆囊管结石1例,术中探查发现胆囊管结石22例.除1例因Mirizzi综合征中转开腹外,22例均顺利完成腹腔镜手术.术后均无胆漏及结石残留,均治愈.结论 腹腔镜胆囊切除术治疗急、慢性胆囊炎合并胆囊管结石,术前诊断明确及术中处理是关键,胆囊管充分游离及伸展、胆囊管剪开及捏挤可有效的预防结石残留.     

腹腔镜胆囊切除术治疗急性胆囊炎

目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎及慢性胆囊炎急性发作的方法及疗效。方法:回顾分析2003年3月- 2006年5月行腹腔镜胆囊切除治疗急性胆囊炎及慢性胆囊炎急性发作患者128例的临床资料。结果:腹腔镜胆囊切除术128例中124例成功,平均手术时间85 min,1例术后出血;4例中转开腹手术,中转开腹率2.34%;并发症发生率0.81%。结论:急性胆囊炎或慢性胆囊炎急性发作病例行腹腔镜胆囊切除术可行、有效,必要时可适当放宽手术指证。解剖胆囊三角显露胆囊管是手术的关键。当腹腔镜手术遇困难时,可适时中转开腹手术。     

腹腔镜治疗萎缩性胆囊炎58例分析

目的：探讨腹腔镜手术在萎缩性胆囊炎治疗中的应用价值。方法：回顾分析2002-2008年间58例萎缩性胆囊炎行腹腔镜胆囊切除术的临床资料。结果：58例中,5例中转开腹（占8.6%）,所有病例术后预后良好,无重大并发症。结论：萎缩性胆囊炎通过腹腔镜切除技术上可行,治疗效果满意。     

Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: a prospective randomized study

OBJECTIVE: Laparoscopic surgery is thought to reduce the postoperative immunologic effects of surgical trauma. The aim of this study is to evaluate the influence of surgical trauma on systemic inflammation and the immune response in acute cholecystitis. MATERIAL AND METHODS: Thirty-three patients with acute calculous cholecystitis were assigned to laparoscopic cholecystectomy (LC, n=18) or open cholecystectomy (OC, n=15). Blood samples were obtained preoperatively and on postoperative day 1 (24 h after surgery) and day 3 (72 h after surgery), and blood concentration of C-reactive protein (CRP), leukocyte subpopulations, as well as levels of tumor necrosis factor-alpha (TNF-alpha) ex vivo secretion by peripheral blood mononuclear cells (PBMCs) were measured in both groups. RESULTS: Hospitalization was significantly shorter in the LC group than in the OC group (LC group: 3.7+/-1.2 days versus OC group: 6.3+/-2.7 days, p=0.010). There was no postoperative morbidity in the LC group, but two patients in the OC group had postoperative complications. Postoperative TNF-alpha ex vivo secretion by PBMCs and PBMC counts in the OC group were significantly lower than those in the LC group (p=0.002). The CRP level declined by postoperative day 3, but was significantly less in the OC group than in the LC group (p<0.001). Postoperative monocyte counts significantly decreased in the OC group compared with those in the LC group (p=0.001). CONCLUSIONS: A laparoscopic approach appears to cause less surgical trauma and immunosuppression than open surgery in patients with acute cholecystitis.     

ELC和DLC治疗急性结石性胆囊炎的临床评估

【目的】评估腹腔镜胆囊切除术（LC）治疗急性胆囊炎的手术时机及效果。【方法】回顾性分析92例LC治疗的急性胆囊炎患者的临床资料,以起病时间≤72h和〉72h分为早期LC（ELC）和延迟LC（DLC）两组进行对比分析。【结果】两组间年龄,性别,手术时间[（89．12±37．59）minvs（77．31±25．65）min,P=0．058],术后住院时间[（4．8±3．13）dvs（4．1±2．23）d,P=0．75],并发症发生率[16．0％（4／25）vs13．43％（9／67）,P=0．073]均无明显统计学差异;但与DLC组比较,ELC组中转开腹率明显降低[8．0％（2／25）vs16．42％（11／67）,P〈0．01],总住院时间缩短（4．72dvs8．54d,P〈0．01）。【结论】ELC治疗急性结石性胆囊炎安全有效。     

腹腔镜胆囊切除术治疗123例急性胆囊炎分析

目的探讨腹腔镜胆囊切除术（LC）治疗急性胆囊炎的疗效。方法对123例急性胆囊炎患者采用腹腔镜胆囊切除术治疗观察其临床效果。结果本组123例除10例中转开腹（占8.13%）外,余均LC手术成功。所有病例术后预后良好,无重大并发症。结论随着LC手术水平的提高,手术方法的不断改进,手术经验的积累,新的手术器械和手术材料的应用,LC已成为外科胆囊切除的首先术式。     

腹腔镜胆囊切除术治疗老年急性结石性胆囊炎的体会

目的:评价腹腔镜胆囊切除术(Laparoscopic cholecystectomy,简称LC)治疗老年急性结石性胆囊炎的效果。方法:2006年～2008年对我院56例老年急性结石性胆囊炎患者行腹腔镜胆囊切除术,术后对其疗效进行评价。结果:对56例66岁～91岁、发病时间在48小时内的老年性急性结石性胆囊炎患者行腹腔镜胆囊切除术,术后随访3月以上,均恢复良好,未发生不良反应。结论:老年结石性胆囊炎急性发作,发病在48小时内如及时就诊,合理治疗合并症,老年人均可耐受LC,手术成功的关键在于术前准备充分,治疗合理、及时,术中操作仔细、认真,术后严密观察病情,积极对症治疗合并症、处理并发症,均可取得良好的效果。     

急性胆囊炎腹腔镜治疗435例临床分析

目的 :总结分析腹腔镜在胆囊急性炎症情况下各种并发症原因 ,结合自身经验探讨如何预防。方法 :回顾性分析我科 2 0 0 0年 10月～ 2 0 0 2年 3月腹腔镜胆囊切除 75 5例中的 4 35例急性胆囊炎资料。结果 :腹腔镜胆囊切除 75 5例中发生胆总管损伤 1例、胆汁漏 3例、剑突下切口内残石伴感染 1例共 5例并发症 ,且全部出现在胆囊急性炎症组。结论 :尽管胆囊急性炎症情况下行腹腔镜切除其难度及出现医源性损伤的可能性很大 ,但只要镜下注意适当的操作 ,完成手术的可能性同样存在。     

急性胆囊炎腹腔镜胆囊切除术1080例临床分析

目的提高急性胆囊炎的腹腔镜手术成功率。方法回顾性分析1993年10月-2006年10月1080例腹腔镜胆囊切除术（1aparoscopic cholecystectomy,LC）治疗急性胆囊炎（acute cholecystitis,AC）的临床资料。结果手术成功1033例,中转开腹47例。全组无严重手术并发症。结论合理运用LC及选择性引流、适时中转,急性胆囊炎行腹腔镜胆囊切除术（LC）是安全有效地。     

腹腔镜与开腹手术治疗胆囊并胆总管结石的内镜应用

目的 探讨内镜参与腹腔镜胆囊切除术（LC）、开腹手术治疗胆囊并胆总管结石的效果.方法 对54例胆囊并胆总管结石病人在LC或开腹手术之前行内镜检查、取石.结果 54例十二指肠逆行胰胆管造影（ERCP）均成功,选择性十二指肠乳头括约肌切开术（EST）取胆总管结石成功49例,占90.74%.EST后选择性LC成功47例,内镜加LC总取石成功者占87.05%,1例EST取石后急性胆囊炎加重中转手术;内镜术后选择性开腹手术成功7例,占12.95%.无严重并发症发生.结论 先行内镜检查、取石,再行LC处理,大部分胆囊并胆总管结石病人可治愈而且并发症少,少部分疑难、复杂者仍需开腹手术处理.     

磁共振胰胆管成像在腹腔镜胆囊切除术前评估中的应用

目的探讨腹腔镜胆囊切除术(LC)治疗胆囊结石伴急性胆囊炎术前应用磁共振胰胆管成像(MRCP)进行评估的临床价值。方法回顾性分析胆囊结石伴急性胆囊炎拟行LC 64例患者的病例资料。所有患者均行B超检查后收治入院,术前行MRCP检查分析肝外胆管变异和排除胆总管结石。结果 2例患者发现胆囊管解剖变异,3例胆总管下端结石患者行开腹胆总管切开取石胆囊切除+"T"管引流术,余61例均行LC。结论胆囊结石伴急性胆囊炎患者LC术前行MRCP检查,有助于观察肝外胆管变异和胆总管结石情况,减少术中胆管损伤和胆总管结石残余的发生。     

胆囊并发胆总管结石患者的微创外科治疗研究

目的探究胆囊并发胆总管结石患者的微创外科治疗。方法选取2013年1月-2018年1月该院收治的92例胆囊并发胆总管结石患者为研究对象,采用随机数字表法将患者分为对照组(n=46)和观察组(n=46)。两组患者中存在胰腺炎的患者先行控制腹膜炎,对照组患者行腹腔镜胆囊切除术(LC)联合胆总管探查取石术(LCBDE),观察组患者行十二指肠乳头括约肌切开取石术(EST),术后3 d行LC治疗。比较两组患者围术期情况、费用情况和并发症情况。结果两组患者均未出现中转开腹手术情况,观察组患者的手术时间、止痛药使用率、住院时间均低于对照组患者,耗材费用和住院总费用多于对照组患者,差异具有统计学意义(P0.05);两组患者的术中出血量、术后排气时间和手术费用比较差异无统计学意义(P0.05)。观察组患者各项并发症总发生率为6.51%低于对照组患者的19.53%,差异具有统计学意义(P0.05)。结论胆囊并发胆总管结石患者控制腹膜炎后行EST+LC治疗较LC+LCBDE治疗能够缩短手术时间,减轻术后疼痛,降低并发症发生率,缩短住院时间,但所需费用较高。     

急性结石性胆囊炎腹腔镜胆囊切除手术临床分析

目的探讨结石性胆囊炎急性炎症期腹腔镜胆囊切除术（LC）的手术技巧及手术指征。方法对急性炎症期LC 221例与同期急性炎症期开腹胆囊切除术（OC）158例作对照,回顾性总结379例急性结石性胆囊炎手术治疗临床资料,体会炎症期LC手术技巧。结果LC组术中情况、切口感染情况、术后平均住院时间均优于OC组。结论急性炎症期LC在具备熟练手术技巧时,是一种安全有效的术式。     

腹腔镜和开腹胆囊切除术对急性结石性胆囊炎患者胃肠功能和CRP的影响

目的探讨腹腔镜和开腹胆囊切除术治疗急性结石性胆囊炎后对胃肠功能和CRP的影响。方法将80例急性结石性胆囊炎行胆囊切除术患者,随机分为两组：腹腔镜组：40例行腹腔镜胆囊切除术;开腹组：行开腹胆囊切除术。对两组患者术后进行胃肠功能评价和CRP检测,进行对比分析。结果急性结石性胆囊炎术后胃肠功能评价：腹腔镜组40例患者,Ⅰ级8例占20．0％、Ⅱ级15例占37．5％、Ⅲ级17例占42．5％;开腹组40例患者,Ⅰ级5例占12．5％、Ⅱ级13例占32．5％、Ⅲ级22例占55．0％。急性结石性胆囊炎术后CRP检测评价：腹腔镜组40例患者,正常6例占15．0％、轻度升高11例占27．5％、中度升高16例占40．0％、重度升高7例占17．5％;开腹组40例患者,正常2例占5．0％、轻度升高13例占32．5％、中度升高14例占35．0％、重度升高11例占27．5％。结论腹腔镜手术时间明显低于开腹手术,避免了开腹后腹腔脏器的暴露,有利于手术后的胃肠功能快速恢复。腹腔镜手术创伤后较开腹手术机体免疫反应轻。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎84例效果观察

目的:探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎患者的临床疗效.方法:将168例急性结石性胆囊炎患者随机分为对照组和治疗组各84例,对照组行传统开腹胆囊切除术,治疗组行腹腔镜胆囊切除术,观察、比较两组手术及术后情况.结果:两组术中出血量、术后应用镇痛药次数、术后排气时间、下床活动时间、术后住院天数、并发症发生率比较差异有统计学意义(P＜0.05,P＜0.01).结论:腹腔镜胆囊切除治疗效果佳,创伤小,患者术后恢复快、痛苦小、并发症少,值得临床推广应用.     

腹腔镜胆囊切除术对急性结石性胆囊炎患者炎症反应、免疫功能及近期生活质量的影响

目的探讨腹腔镜胆囊切除术对急性结石性胆囊炎患者炎症反应、免疫功能及近期生活质量的影响。方法回顾性分析2017年6月至2019年5月于我院普外科接受开腹胆囊切除术(对照组,40例)与腹腔镜胆囊切除术(观察组,40例)的急性结石性胆囊炎患者的临床资料。比较两组的治疗效果。结果观察组的手术时间短于对照组,术中出血量少于对照组(P<0.05)。术后12、24、36、48 h,观察组的VAS评分均低于对照组(P<0.05)。术后第1~3天,观察组的C反应蛋白、白细胞介素-6水平均低于对照组(P<0.05)。术后,观察组的CD3+、CD4+/CD8+均高于对照组(P<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。观察组的生理领域、心理领域、环境领域、社会关系领域评分均高于对照组(P<0.05)。结论腹腔镜胆囊切除术用于急性结石性胆囊炎患者中具有微创性的优点,可切实减少术中出血量,减轻术后疼痛感和炎症反应,保护免疫功能,有利于减少术后并发症的发生,提高近期生活质量。     

老年患者腹腔镜胆囊切除112例分析

目的总结腹腔镜胆囊切除术在老年患者中的应用经验,提高手术的安全性和成功率。方法回顾性分析112例老年腹腔镜胆囊切除术患者的临床资料,其中急性胆囊炎21例,慢性胆囊炎91例。结果本研究患者成功实施腹腔镜下胆囊切除102例,成功率为91.1%,中转开腹手术10例（8.9%）,术后并发症11例（9.8%）。结论加强围术期处理,提高手术技术,对预防老年患者腹腔镜胆囊切除术术后并发症是十分必要的。     

Laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports

BACKGROUNDGangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious course. We herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis, who safely underwent laparoscopic cholecystectomy (LC) and both demonstrated a good outcome.CASE SUMMARYCase 1: An 89-year-old female. She underwent abdominal contrast-enhanced computed tomography (CECT) due to abdominal pain and diarrhea. Her gallbladder wall indicated the absence of contrast enhancement, thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent LC. Although her gallbladder demonstrated diffuse necrosis and it was also partly perforated, she was able to be discharged without any serious complications. Case 2: A 91-year-old female. She made an emergency visit with a chief complaint of abdominal pain. Abdominal CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder wall. She was diagnosed with gangrenous cholecystitis and underwent LC. Her gallbladder had swelling and diffuse necrosis. Although her preoperative blood culture was positive, she showed a good outcome following surgery.CONCLUSIONAlthough a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery, if an early diagnosis can be made and appropriate treatment can be carried out, then even very elderly individuals may be discharged without major complications.     

The safety of a laparoscopic cholecystectomy in acute cholecystitis in high-risk patients older than sixty with stratification based on ASA score.

The purpose of this study was to evaluate the safety of a laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in patients older than sixty years of age, with stratification based on the ASA (American Society of Anesthesiologists) score. For five years, 137 patients older than sixty, who had undergone a LC for AC, were classified into three groups; ASA 1 (n = 33), ASA 2 (n = 79) and ASA 3 (n = 25). Preoperative percutaneous gallbladder drainage was performed in eight of the 137 cases (5.8%). All except one underwent one-stage management and 19.7% patients underwent emergency surgery within 24 hours of the index admission of AC. The preoperative hospital stay for ASA 3 (8.8 days) was longer than that for ASA 1 (5.6 days). There was a higher proportion of complicated cholecystitis and a longer operating time in ASA 2 (50.6%, 111 min.) and 3 (66.7 %, 114 min.) than in ASA 1 (24.2%, 85 min.) (p<0.05). Morbidity was more frequent in ASA 3 (20.0%) than in ASA 1 (9.1%). However, the open conversion rate, time to diet, and postoperative hospital stay were similar in the three groups (p>0.05). We conclude that a LC for AC may be an effective treatment option in elderly-high risk patients.     

腹腔镜治疗急性胆囊炎389例临床分析

目的：探讨急性胆囊炎行腹腔镜手术的可行性。方法：回顾分析2002年1月—2008年12月389例发作时间超过3d并且胆囊囊壁厚〉5mm的急性胆囊炎行腹腔镜下胆囊切除术的临床资料。结果：389例中377例（96.92%）腹腔镜下完成手术。4例因Calot三角呈冰冻状无法分离,8例因渗血严重中转开腹,中转率为3.08%。1例术后并发肝脓肿,后经B超引导穿刺引流后治愈。无死亡病例。结论：腹腔镜下胆囊切除术是治疗急性胆囊炎的一种安全方法。