腹腔镜手术治疗颈部结石嵌顿性急性胆囊炎88例临床分析

目的:探讨颈部结石嵌顿性急性胆囊炎患者行腹腔镜胆囊切除术的特点及手术技巧。方法:回顾分析88例胆囊颈部结石嵌顿性急性胆囊炎患者行腹腔镜手术的临床资料。结果:87例均顺利完成腹腔镜胆囊切除术,其中2例M irizzi综合征Ⅰ型行腹腔镜胆囊部分切除术,1例合并胆囊十二指肠瘘中转开腹。结论:颈部结石嵌顿性急性胆囊炎患者行腹腔镜手术安全可行,术中如胆囊颈部粘连致密无法解剖,胆囊与邻近脏器内瘘形成应及时中转开腹。     

腹腔镜手术治疗颈部结石嵌顿性急性胆囊炎90例临床分析

目的颈部结石嵌顿性急性胆囊炎患者行腹腔镜胆囊切除术的经验。方法回顾性分析90例颈部结石嵌顿性急性胆囊炎患者行腹腔镜胆囊手术的临床资料。结果 90例完成LC,7例中转开腹,其中Mirizzi综合征1例,胆囊三角区严重粘连呈"冰冻状"4例,出血1例,与周围组织严重粘连1例。术后1例胆漏。结论颈部结石嵌顿急性胆囊炎只要完善患者病情的术前评估,合理选择手术适应征,根据术中情况采取相应术式,颈部结石嵌顿性急性胆囊炎行腹腔镜手术是安全可行的。     

腹腔镜治疗结石嵌顿性胆囊炎78例手术体会

目的探讨腹腔镜手术在治疗结石嵌顿性胆囊炎的应用价值、并发症的防治和注意事项。方法回顾性分析我院2002年至2008年腹腔镜胆囊切除(LC)78例结石嵌顿性胆囊炎的临床资料。结果成功完成腹腔镜胆囊手术70例,胆总管损伤2例,右肝管损伤1例,术中出血5例,分别经胆总管修补加"T"管支撑,中转开腹止血加腹腔引流管引流而治愈,本组无死亡病例。结论腹腔镜对治疗结石嵌顿性胆囊炎胆囊切除是安全可行的。     

腹腔镜胆囊切除术治疗急性结石嵌顿性胆囊炎

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗急性结石嵌顿性胆囊炎的可行性和价值。方法2005年1月～2007年12月71例急性结石嵌顿性胆囊炎全麻下行四孔法LC,分别处理胆囊动脉和胆囊管,若胆囊管增宽则先结扎再切断,撑开状态下电灼肝床边缘,术后放置肝下引流。结果67例（94.4%）成功完成LC,4例（5.6%）中转开腹（68例病程3d以内,中转开腹2例;3例病程3d以上,中转开腹2例）。无胆管损伤,无死亡。术后住院2～6d,平均3d。71例术后随访半年无手术并发症。结论随着手术熟练程度及手术技巧的提高,LC治疗急性结石嵌顿性胆囊炎安全、可行。     

结石嵌顿性胆囊炎的腹腔镜手术体会

目的:探讨胆囊颈部结石嵌顿性胆囊炎腹腔镜胆囊切除术(LC)的手术方法。方法:回顾分析102例胆囊颈部结石嵌顿性胆囊炎行LC的临床资料。结果:94例完成LC,8例中转开腹。结论:术者熟练的操作是胆囊颈部结石嵌顿性胆囊炎LC成功的关键,胆囊颈部结石嵌顿性胆囊炎行LC是安全可行的。     

腹腔镜治疗结石嵌顿性胆囊炎的体会

目的探讨腹腔镜胆囊切除术（LC）中处理胆囊颈及胆囊管结石的方法。方法回顾性总结1999年12月～2004年5月我院对52例结石嵌顿性胆囊炎的体会。结果52例中50例在腹腔镜下完成手术全过程，其中5例胆囊大部分切除加腹腔多孔管引流，2例中转开腹，均痊愈，疗效满意。结论结石嵌顿性胆囊炎可采用腹腔镜手术，术中关键是要注意辨-切-辨三字原则，可避免出现胆漏、胆管损伤等严重并发症。     

胆囊颈部结石嵌顿的腹腔镜手术体会

目的 通过总结胆囊颈部结石嵌顿的腹腔镜手术体会,进一步提高手术技巧,降低中转开腹率,减少并发症。方法 胆囊颈部结石嵌顿行腹腔镜胆囊切除术(LC术)时要注意分离周围粘连时应紧贴胆囊壁,勿损伤结肠,十二指肠,胆囊必须减压。应用合理技巧牵开有结石嵌顿的Hartmann囊,显露Calot三角。游高胆囊时紧贴结石嵌顿处再向胆总管方向游离,分离胆囊床时一定在胆囊与肝脏之间。结果 我院以96年5月97年9月共实施LC术158例,经手术证实结石嵌顿于胆囊颈部16例,其中一例中转开腹,中转开腹率6.25％。结论 综上我们认为急性胆囊炎合并胆囊结石嵌顿于胆囊颈部行LC术时,通过合理的操作技巧,是能够可以成功的。从而降低了LC术的中转开腹率。     

腹腔镜胆囊切除术治疗结石嵌顿性胆囊炎的体会

目的总结腹腔镜胆囊切除术(laparoscopic cholecystectomy LC)治疗结石嵌顿性胆囊炎的体会。方法对65例结石嵌顿性胆囊炎行LC,回顾性分析患者的临床资料。结果本组中62例患者顺利完成LC,未发生与手术相关的并发症。3例中转开腹手术。结论术前完善检查,合理评估手术方式,术中熟练规范操作,可提高结石嵌顿性胆囊炎LC治疗的有效率,减少并发症。     

腹腔镜胆囊大部切除术456例报告

目的探讨对难处理的结石性胆囊炎患者经腹腔镜施行胆囊大部切除术的效果。方法1998年1月至2008年6月对456例难处理的结石性胆囊炎（急性胆囊炎35例，慢性结石性胆囊炎急性发伴嵌顿350例，坏疽性胆囊炎26例，萎缩性胆囊炎40例，Murizzi综合5例），采用经腹腔镜施行胆囊大部切除术。结果患者都顺利完成腹腔镜胆囊大部切除术，手术未发生胆管损伤，大出血及中转开腹，随访1月～10年无异常发现。结论对难处理的结石性胆囊炎患者施行腹腔镜胆囊大部切除术是一种具有预防医源性胆道损伤，避免术中导致大出血而中转开腹的微创手术方法。     

腹腔镜手术治疗嵌顿性胆囊结石235例分析

本文报告我院近２年２３５例嵌顿性胆囊结石的腹腔镜手术治疗经验，研究了急性和慢性嵌顿性胆囊结石的诊断、分型和处理方法。全组慢性嵌顿性胆囊结石２２１例，急性嵌顿性胆囊结石１４例，占同期腹腔镜胆囊切除术总数（１４７５例）的１５．９％。９例中转开腹手术，其中７例为胆囊周围或ｃａｌｏｔ三角严重粘连，１例为急性坏疽性胆囊炎、１例为结石嵌顿于胆囊管与肝总管交界部，中转开腹率３．８％。术后并发胆瘘２例，经引流自行愈合，全组无腹腔感染及死亡。     

Laparoscopic and open cholecystectomy in New York State: mortality, complications, and choice of procedure

BACKGROUND: With the advent of laparoscopic cholecystectomy patient outcomes and choice of procedure (laparoscopic vs open) are of vital interest. The purpose of this study was to examine the mortality and complication rates for patients undergoing laparoscopic and open cholecystectomy in New York State and to test for differences among hospital peer groups and regions of the state in the tendency to use the laparoscopic approach. METHODS: A population-based, retrospective cohort study of laparoscopic and open cholecystectomy was conducted in which data were analyzed on all 30,968 patients who underwent cholecystectomy as a principal procedure in New York State in 1996. RESULTS: A total of 78.7% of the 30,968 patients who underwent cholecystectomy as a principal procedure in New York State in 1996 underwent laparoscopic cholecystectomy. The mortality rate was lower for laparoscopic cholecystectomy than for the open procedure (0.23% vs 1.90%, P < .0001) and remained significantly lower after patient characteristics related to patient survival (odds ratio 0.34, P < .0001) were controlled for. The prevalence rate of the 8 most common complications among cholecystectomy patients was also much lower among patients undergoing laparoscopic cholecystectomy. Patients undergoing cholecystectomy in public hospitals, Bronx County, and Kings County were found to be significantly less likely to have laparoscopic procedures, and patients undergoing cholecystectomy on Long Island were found to be significantly more likely to have laparoscopic procedures than were other patients in the state. CONCLUSIONS: There are reasonably large differences among hospitals, hospital groups, and regions of the state in the type of cholecystectomy used, even after adjustment for differences in patient comorbidities and indications for type of procedure.     

Post-cholecystectomy symptoms after laparoscopic cholecystectomy.

Abdominal symptoms persist in up to 40% of patients after laparotomy cholecystectomy and biliary lithotripsy. Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstone disease. However, no data exist as to the influence of laparoscopic cholecystectomy on symptoms. We analysed 100 patients who had undergone laparoscopic cholecystectomy at a median of 12 months (range 10-19 months) previously. Pre- and postoperative symptoms were compared and patient satisfaction was graded from 1 (best) to 5 (worst). Time to resumption of full activity (mean +/- SD) was recorded. All patients had more than two symptoms preoperatively. Postoperatively, 61 patients had complete absence of symptoms, 14 patients complained of only one symptom during the postoperative period and 25 patients continued to have at least two symptoms. The mean time taken to return to full activity was 2.4 +/- 1.7 weeks. In patients without any symptoms postoperatively, time taken to return to full activity was 2.3 +/- 1.5 weeks, 2.7 +/- 1.4 weeks for patients with one symptom postoperatively, while patients with two or more symptoms returned to full activity in 2.3 +/- 1.3 weeks and 2.6 +/- 1.7 weeks, respectively. Notwithstanding that 25% of patients reported two or more symptoms postoperatively, most patients (n = 84) considered the procedure to be a complete success. A further 10 patients had significant improvement after laparoscopic cholecystectomy. Five patients considered themselves only slightly improved, while a single patient was no better off postoperatively. These data indicate that after laparoscopic cholecystectomy most patients return to full activity within 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of fundus-first laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients

BACKGROUND: Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the loss of the advantages of this minimally invasive procedure and significantly increases length of hospital stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent among patients with acute cholecystitis and in elderly patients. This study evaluated whether fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with acute cholecystitis. MATERIALS AND METHODS: During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care university hospital in central Taiwan. RESULTS: The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications--port-site infection and subhepatic fluid collection-occurred in two patients (5.5%). CONCLUSION: Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon.     

腹腔镜下萎缩性胆囊炎切除方法的探讨

目的：总结腹腔镜下慢性结石性萎缩性胆囊炎胆囊切除的手术方法和经验。方法：总结2003年1月～2007年5月36例慢性结石性萎缩性胆囊炎患者行腹腔镜胆囊切除术中分离胆囊周围粘连、解剖Calot三角、处理胆囊管及胆囊动脉、切除胆囊的方法。结果：腹腔镜下胆囊切除30例,中转开腹6例。4例胆囊三角区广泛致密粘连,无法分离,行开腹胆囊大部切除术。腹腔镜术后胆漏2例,经腹腔引流治愈。结论：萎缩性胆囊炎腹腔镜手术治疗是安全的。仔细分离胆囊周围粘连,辨认壶腹部与胆囊管的交界,准确解剖Calot三角,合理处理胆囊管,正确掌握中转开腹时机是成功完成手术的关键。     

Laparoscopic cholecystectomy in pancreas transplant recipients

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Since its introduction in 1987, this procedure has been employed with increasing frequency as its safety has been documented in numerous studies. Absolute contraindications to laparoscopic cholecystectomy have become relative contraindications, and patients previously felt to be at excessive risk for laparoscopic cholecystectomy are viewed as patients who may benefit from laparoscopic cholecystectomy. The use of this procedure in patients with comorbid medical conditions has the potential to decrease patient morbidity. Patients who have previously undergone solid organ transplantation and require immunosuppressive therapy are a group of patients who may benefit from laparoscopic cholecystectomy. We report four patients who have previously undergone combined renal and pancreas transplantation who underwent successful laparoscopic cholecystectomy.     

Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital

Background and aims Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery. The aim of this study was to compare the results of the laparoscopic, open and mini-laparotomy approaches to cholecystectomy.Patients and methods Our study covers a period of 6 years. A total of 1,276 patients underwent cholecystectomy for calculous biliary disease. The laparoscopic procedure was applied to 952 (74.6%) patients, while 210 (16.5%) underwent the traditional open cholecystectomy and the remaining 114 (8.9%) patients underwent mini-laparotomy cholecystectomy.Results Thirty-seven patients (3.9%) from the laparoscopic group required conversion to open cholecystectomy. Morbidity was similar in the open and laparoscopic groups (3.8%), while it was significantly lower in the mini-laparotomy group (0.8%). No major bile duct injuries occurred after the open or mini-laparotomy approaches. The median operation time was significantly shorter in the mini-laparotomy group than in the laparoscopic group (46 min vs 61 min). Hospital stay was significantly longer for the open cholecystectomy group (mean value 5.1 days) compared with the laparoscopic and mini-laparotomy groups (mean values 2.5 days and 2.7 days, respectively). Hospital expenses showed a saving of 786€ for each patient who underwent the open procedure and 980€ for each patient who underwent the mini-laparotomy approach compared with the laparoscopic one.Conclusion We believe that commissioners of healthcare should question whether the benefits of laparoscopic cholecystectomy justify the additional cost after the introduction of the mini-laparotomy approach.     

Cost-effectiveness of laparoscopic cholecystectomy

This study retrospectively evaluated the cost-effectiveness of laparoscopic cholecystectomy compared to open cholecystectomy in a single university-affiliated community hospital. The medical records of all patients that underwent laparoscopic cholecystectomy during 1990 and open cholecystectomy during 1989 in one hospital were reviewed. Hospital stay, hospital charges, surgeons' and anesthesiologists' fees were determined. Fifty patients from each group were contacted to determine recovery time to full activity after surgery. Those having common duct exploration and those converted to open cholecystectomy after an attempted laparoscopic cholecystectomy (n=8) were excluded. A summary of results is included below (Table 1).In our early experience with laparoscopic cholecystectomy we found that the total charges for laparoscopic cholecystectomy were more than for open cholecystectomy when one recognizes the 1-year difference in patient accrual between the two groups. Time to full recovery was markedly reduced in patients undergoing laparoscopic cholecystectomy compared to those having an open procedure. Despite the overall increased total charge with laparoscopic cholecystectomy, the shorter recovery period allowing the patients an earlier return to full preoperative activities contributes to its cost-effectiveness when compared to open cholecystectomy. Further experience with laparoscopic cholecystectomy and refinements in management of these patients should allow for further reductions in charges for this procedure.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 18–19 April 1994The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the DOD, the USAF, or of other federal agencies. The authors above are responsible for the contents of the paper.     

Open cholecystectomy: a control group for comparison with laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is rapidly becoming accepted as the best method for the treatment of symptomatic cholelithiasis. Randomized clinical trials comparing laparoscopic cholecystectomy with open cholecystectomy are unlikely to be performed. In order to compare these two operations, surgeons need an historical control group of patients who have undergone a conventional open cholecystectomy. The aim of this study was to document a control group of patients having an open cholecystectomy and compare them with patients having a laparoscopic cholecystectomy. This was achieved by a retrospective study of all patients who had an open cholecystectomy from January 1985 to December 1989. Four hundred and fifty-seven patients, 345 women and 112 men, had a cholecystectomy. Exploration of the common bile duct (ECBD) was performed in 59 (12.5%) cases. The mean operative duration was 73 min for cholecystectomy and 118 min for cholecystectomy and ECBD. The shortest mean postoperative stay was for an elective cholecystectomy (5.3 days) and the longest mean postoperative stay was for urgent admissions requiring ECBD (12.0 days). Operative dissection was difficult in 14.1% of elective cases and 51.8% of urgent cases. Ninety-seven (19.5%) patients had an additional procedure, unrelated to cholelithiasis, at the same operation; 44 did not require laparotomy, 31 had interval appendectomies, and 22 other cases required laparotomy in order to perform the additional procedure. All but one patient required postoperative narcotic analgesia. The mean duration of narcotic analgesia was 2.3 days. The complication rate was 35.2% for cholecystectomy and 62.5% for ECBD. If pulmonary atelectasis is excluded as a complication, these complication rates fell to 6.8% and 20.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of Postcholecystectomy Symptoms: Long-term Outcome after Open versus Laparoscopic Cholecystectomy

After cholecystectomy a certain number of patients continue to suffer from abdominal symptoms or develop such symptoms postoperatively. The aim of this study was to compare the prevalence of postcholecystectomy symptoms with open cholecystectomy during the prelaparoscopic era and those with laparoscopic cholecystectomy 4 years after introduction of the laparoscopic technique. Between July 1988 and June 1989 a total of 163 consecutive patients with elective open cholecystectomy and between September 1994 and August 1995 a total of 234 consecutive patients with elective laparoscopic cholecystectomy were prospectively evaluated using a standard questionnaire about preoperative symptoms, diagnostic modalities, and intraoperative findings. After a minimum of 12 months the patients were interviewed by telephone. Since the introduction of the minimal invasive technique the number of cholecystectomies performed at our institution increased. There was no significant difference in the prevalence of postcholecystectomy symptoms found after the open procedure compared with laparoscopic cholecystectomy: 90% of patients after open and 94% after laparoscopic cholecystectomy had no or only minor symptoms.     

Open versus laparoscopic cholecystectomy: an initial analysis.

Laparoscopic cholecystectomy is a new procedure in the armamentarium of the general surgeon. Its utility was investigated by comparison to open cholecystectomy in terms of procedure time, complications, hospital stay, and total hospital cost. Procedure time was approximately 200% longer with a higher incidence of intraoperative stone and bile spillage (17%) in the laparoscopic group. Hospital stay was reduced by 60% using the laparoscopic technique. No difference in total hospital cost existed between the two groups. The learning curve had an affect on hospital costs, which will decrease as more experience is gained with this procedure. Although laparoscopic cholecystectomy, at least initially, has no cost advantage over open cholecystectomy, laparoscopic cholecystectomy may be preferred by patients seeking shorter hospital stays and presumably shorter total recovery time.