腹腔镜胆囊切除术并发症的防治

为了提高腹腔镜胆囊切除术（ＬＣ）的安全性，作者对６００例ＬＣ的并发症加以回顾性总结。结果全组共发生并发症２９例（术中１４例，术后１５例），占４．８３％，包括胆管损伤２例，出血９例，皮下气肿２例及胃窦穿孔１例。中转剖腹１４例，其中因术中出现并发症中转４例，因术后并发症再手术２例，全组均治愈出院。因此，及时中转剖腹是避免严重并发症的重要措施，为了积极稳妥地开展ＬＣ手术，手术并发症的防治值得重视。     

经腹腔镜胆囊切除术1650例的经验

本文报告我院为各种类型的胆囊良性疾病患者行腹腔镜胆囊切除术（ＬＣ）１６５０例，中转手术３２例，发生各种并发症３１例，其中肝外胆管损伤４例，术后需剖腹止血３例，胆囊管残端瘘１例。治愈１６４９例，死亡１例。重点讨论ＬＣ手术的并发症与学习曲线，中转开腹手术指征，强调ＬＣ术中正确辩论胆囊壶腹与胆囊管交界部在预防肝外胆管损伤中的作用和地位。     

腹腔镜胆囊切除术治疗复杂性胆囊结石的评价

为了评价腹腔镜胆囊切除术（ＬＣ）治疗复杂性胆囊结石的有效性和安全性，本文对比分析了手术时间、中转开腹手术率、并发症发生率和住院时间等项指标。结果表明，单纯组和复杂组平均手术时间分别为３１．６和４５．７分钟（Ｐ＜０．０５）；中转开腹手术率分别为１．０％和７．４％（Ｐ＜０．０１）；住院时间复杂组长于单纯组。单纯组９９％的病人、复杂组９０％以上的患者能够采用ＬＣ治愈。两组术后并发症发生率无显著差异。两组总中转开腹手术率为２．７％。本文结果提示，ＬＣ用于治疗伴有各种并发症的复杂性胆囊结石是可行的，同样可以保留和体现出它的优越性。     

老年人经腹腔镜和剖腹胆囊切除术对围手术期肺功能影响的比较

目的 比较经腹腔镜和剖腹胆囊切除术对老年人围术期肺功能的影响。方法 １２０例在全身麻醉下经腹腔镜和剖腹行胆囊切除术的老年患者分别为肺功能正常和异常组,术中监测肺功能多项指标,比较手术对肺功能的影响。结果 （１）腹腔镜肺功能正常组和异常组：ＣＯ２气腹后气末二氧化碳分压（ＰｅｔＣＯ２）、气道人压（Ｐｐｅａｋ）、气道平台压（Ｐｐｌａｔ）、动脉血二氧化碳分压（ＰａＣＯ２）均明显增高,分别上升１４．５％、４     

老年人经腹腔镜胆囊切除应注意的几个问题

对３２例老年胆囊结石、胆囊息肉患者经腹腔镜胆囊切除术（ｌａｐａｒｏｓｃｏｐｉｃｃｈｏｌｅｃｙｓｔｅｃｔｏｍｙ，ＬＣ）进行了总结。３２例中，慢性胆囊炎、胆囊结石２０例，胆囊息肉４例，急性胆囊炎６例，胆囊癌２例，病程２８天～２３年。ＬＣ治愈３０例，术后２４小时均恢复肠蠕动，进流食，下床活动，术后住院４～７天。该手术创伤小，疼痛轻，胃肠道功能恢复快，更适于老年人或伴有心肺疾病的患者。中转开腹手术２例（６．３％），其中１例因胆囊与周围组织紧密粘连，无法分离，开腹后诊断胆囊癌，行胆囊及胆囊床楔形切除，局部淋巴结切除术；另１例因术中胆囊动脉出血，开腹行胆囊切除术。我们认为良好的围手术期处理，老年人可以耐受腹腔镜胆囊切除术，但术前对并存症进行有效的控制及术中加强监测至关重要。     

腹腔镜胆囊切除术严重手术并发症的预防

目的评价腹腔镜胆囊切除术（ＬＣ）的安全性和有效性，对２８８０例ＬＣ及其并发症的预防加以总结．方法对２８８０例良性胆囊疾病患者行ＬＣ，术前选择性地行ＥＲＣＰ等影像学检查．结果ＬＣ时中转开腹胆囊切除术１２３例（４３％），中转原因多为Ｃａｌｏｔ三角粘连严重，解剖结构不清楚．共发生各种并发症２１例（０７２％），其中胆漏４例，出血３例，膈下积液５例，十二指肠穿孔１例，胆总管残留结石８例，均治愈．无手术死亡病例，也无胆道损伤等严重并发症发生．结论手术者的胆道外科素质，选择性术前ＥＲＣＰ检查，慎重细致的手术操作，是预防胆道损伤等严重手术并发症发生的重要因素．     

腹腔镜胆囊切除术的围手术期处理

腹腔镜胆囊切除术（ｌａｐａｒｏｓｃｏｇｉｃｃｈｏｌｅｃｙ－ｓｔｅｃｔｏｍｙ，ＬＣ）是近年开展的一种新型外科技术，本文结合１２４例临床经验，讨论如下：一、一般资料：本组中男５１例，女７３例，年龄２４～６３岁，胆囊结石伴慢性或急性胆囊炎８６例，胆囊息肉３７例，胆囊场１例，其中合并肝硬化者１例，有下腹部手术史（阑尾切除、剖腹产）４例，成功地施行了ＬＣ者１１４例，术中中转刻腹胆囊切除者１０例，术后住院时间４～７天。二、并发症：共１０例，包括：肺炎１例、胸腹壁皮下气肿２例，切口渗血或皮下瘀血４例，胆漏、胆…     

“三管一孔一脏器”显露在预防腹腔镜胆囊切除术胆管损伤的价值

目的研究胆囊各种病理形态、胆囊动脉变异和胆囊管变异情况下，腹腔镜胆囊切除术（ＬＣ）胆管损伤防治预案．方法ＬＣ患者１０６５例，急诊ＬＣ２０７例，择期ＬＣ８５８例，在全麻、ＣＯ２气腹状态下，采用经Ｃａｌｏｔ’ｓ三角后侧径路方法，显露“三管一孔一脏器”（ＴＯＯ）作为胆囊切除术的安全标志．结果“ＴＯＯ”显露１０２１例，占９５８６％，未显露４４例，占４１４％．胆囊动脉变异１４０例，胆囊管变异１５２例，均经ＬＣ顺利完成．全组无胆管损伤等并发症和死亡．结论“三管一孔一脏器”显露在ＬＣ预防胆管损伤起着重要作用．     

Mirizzi综合征的诊断与腹腔镜胆囊切除术治疗的体会

目的 探讨Ｍｉｒｉｚｚｉ综合征的诊断和应用腹腔镜胆囊切除术（ＬＣ）治疗１型Ｍｉｒｉｚｚｉ综合征。方法 对３５例１型Ｍｉｒｉｚｚｉ综合征病例,在诊断和ＬＣ的方法进行回顾性分析。结果 该综合征１型在术前确诊２６例（７４．２９％）,其中临床症状结合Ｂ诊断１１例（２５．７１％）,３５例ＬＣ中转开腹胆囊切主４例,延期剖腹及ＥＲＣＰ诊断１５例（５７．６９％）,术中确诊９例（２５．７１％）。３５例ＬＣ中 工腹胆     

腹腔镜胆囊切除术作为急性胆囊炎治疗选择的评价

目的　对腹腔镜胆囊切除术（ＬＣ）作为急性胆囊炎的治疗选择作出评估。方法　采用回顾性调查方法对ＬＣ治疗的２０７ 例胆囊结石伴急性胆囊炎患者的中转开腹、术后并发症情况及影响中转开腹的一些因素进行研究。结果　本组中转开腹率达３２．３％ ,中转开腹的术后并发症发生率（２０．９％ ）显著高于非中转开腹病例（５．７％ ）。影响中转开腹的因素有患者的性别,急性胆囊炎的胆囊状况,现病史长短,发病至手术的时间及外周血白细胞计数等。结论　对急性胆囊炎选择ＬＣ应慎重,对经判断中转风险较高的病例,不宜选择ＬＣ。     

Bilateral adrenalectomy for Cushing's syndrome: a comparison between laparoscopy and open surgery

We report our experience with bilateral adrenalectomy for treatment of Cushing's syndrome and we compare the outcome of laparoscopy with open surgery in terms of effectiveness and safety. A series of 23 patients underwent bilateral adrenalectomy for treatment of Cushing's syndrome [Cushing's disease in 16, ectopic ACTH syndrome in 2, and ACTH-independent macronodular adrenal hyperplasia (AIMAH) in 5 cases]. From 1993 to 1996, all patients were treated using an open approach (Group A), while from 1997 all patients were treated using a transperitoneal laparoscopic approach (Group B). The comparison between the 2 groups was performed considering patients characteristics, operative times, blood losses, intraoperative and post-operative complications, analgesic consumption, post-operative hospital stay and recovery. Open surgery was performed in 10 patients and laparoscopy in 13 patients. No significant difference was recorded between the two groups as to patients' characteristics and complications. Mean operative time was significantly increased in Group B, while post-operative hospital stay was significantly longer in Group A. Laparoscopic bilateral adrenalectomy can be safely and effectively employed to treat Cushing's syndrome. However, long operatives times may represent a limitation especially in high risk patients.     

Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases

BACKGROUND/AIMS: Laparoscopic colorectal surgery, particularly for malignancy, is still debated. The aim of this study was to prospectively evaluate the postoperative outcome as well as the short- and medium-term results of laparoscopic surgery compared with those after open conventional surgery. METHODOLOGY: A series of 310 consecutive patients, operated on by the same surgical team, have been included in this study; 150 patients (75% with malignant lesions) underwent laparoscopic surgery, whereas 160 patients (73% with malignant lesions) were treated by open surgery. The treatment modality was selected by the patients after reading the informed consent form. RESULTS: Laparoscopic surgery was technically feasible in 91.4% of cases. Mean operative time for laparoscopic surgery was longer than for open surgery (251 vs. 175 min) (P < 0.001). Mean postoperative hospital stay after laparoscopic surgery was 10.5 days, as compared to 13.3 days after open surgery (P < 0.05). In the laparoscopic surgery group minor complications' rate was 3.6% and compared favorably to the 7.5% observed after open surgery (P = 0.261). No statistically significant difference was observed in the major complications rate (9.4% after laparoscopic surgery and 6.8% after open surgery) and in operative mortality (1.4% for laparoscopic surgery and 0.6% for open surgery). The local recurrence rate was lower after laparoscopic surgery as compared to open surgery: 3% versus 9.2% (P = 0.152), respectively. Mean follow-up was 34.2 months during which time we observed 2 cases of port site recurrence. After implementing adequate prophylactic measures, no parietal implants were observed in the last 80 patients who underwent laparoscopic surgery for malignancy. Distant site metastases occurred in 11% in both groups. At 36 months cumulative survival probability in laparoscopic surgery completed malignant cases was 0.74% as compared to 0.66% after open surgery. CONCLUSIONS: Morbidity and mortality were similar in the 2 groups. Laparoscopic patients experienced less pain. A slightly higher incidence of local recurrence was observed in the open surgery group, whereas the percentage of distant site metastases and the cumulative survival probability in the 2 groups were similar. Port site recurrences are a cause of concern but they can be prevented with adequate prophylactic measures. The short- and medium-term results of laparoscopic surgery compared favorably with those of open surgery in this prospective non-randomized study. Long-term oncological result are not known yet. In patients with malignancy prospective randomized trials on larger patient numbers are required.     

体外循环中脑部并发症56例报告

本文报告６０３７例体外循环中发生脑部并发症５６例，其中脑缺氧３５例，脑气栓１０例，脑血栓７例，脑出血２例，脑水肿２例。本文详细论述脑并发症产生的原因，并认为体外循环中提高灌注流量和灌注压是降低脑缺氧的重要方法。此外，还强调术中应用多种微栓过滤器是提高体外循环质量、降低脑并发症的重要措施。     

Current Status of Laparoscopic Surgery in China: Review of more than 150,000 Cases

To review the use of laparoscopic surgery in China, in 1997 the Chinese Society of Laparoscopic Surgery sent questionnaires to all hospitals which undertake laparoscopic surgery. Analyzable questionnaires were returned from 222 hospitals. A total of 156,515 patients in 222 hospitals had undergone laparoscopic surgery by the end of March, 1998. These included 50 categories of laparoscopic general surgery, 9 categories of gynaecologic surgery, 7 categories of urological surgery, and 13 categories of thoracoscopic surgery. Laparoscopic cholecystectomy accounted for 91% of all 156,515 cases. Among these 3005 cases (2.1%) were changed to open cholecystectomy or lapa-rotomy, and 1025 cases (0.71%) developed operative complications, with a mortality of 0.02% (27 cases). The mean rate of bile duct injury was 0.19% (range 0–2%) with bile leak in 0.14%, hemorrhage in 0.11%, and bowel injuries in 0.04% of patients. Since its introduction in 1991 in China, laparoscopic surgery has become increasingly widely used, especially for choecystectomy. It should continue to develop with further economic progress in China. (Dig Endosc 1999; 11: 215–219)     

Colorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial.

BACKGROUND/AIMS: The purpose of this perspective study was to define the role of laparoscopic surgery in the treatment of colorectal carcinoma. METHODOLOGY: One hundred colorectal cancer patients were submitted to surgical treatment between 1993 and 1996. Fifty patients were operated on by videolaparoscopy, the other 50 were operated on according to the standard "open" technique. The two groups had similar demographic (age, gender), pathological (site, stage), and surgical (type and extent of resection) data. Early and late results, benefits and drawbacks of the minimally invasive technique are compared to those of standard open surgery. RESULTS: No intra-operative complications and no operative mortality occurred in the two groups. Early results (complications within 30 days from surgery) were: 1 pneumonia, 3 wound sepsis, and 3 fistulas (one required a reoperation) in the laparoscopic group; 2 wound sepsis and 5 fistulas (spontaneously recovered) in the open group. Late complications occurred in the laparoscopic group only: 1 bowel bridle occlusion 2 months after surgery (that required a reoperation), and 2 stenoses of the colorectal Knight-Griffen anastomosis, successfully treated by dilatation. Concerning the oncologic results, data were calculated on 40 laparoscopic and 43 open curative resections (stage I, II and III): 20% (8/40) of the laparoscopic and 23% (10/43) of the open group patients resulted in neoplastic progression. The neoplastic recurrences were single site (liver or regional) in 3 laparoscopic and in 5 open patients; multiple sites of relapse were observed in 5 laparoscopic (liver, peritoneum and 1 trocar site) and in 5 open (liver, peritoneum and 1 scar) cases. Five-year disease-free survival rates (Kaplan-Meier method) were similar in the two groups: 73.2% in the laparoscopic and 70.1% in the open. CONCLUSIONS: Laparoscopic surgery seems to be a feasible and effective treatment of colorectal cancer and, with the improvement of technology and surgeon skill, it will represent an excellent alternative to the more diffuse and consolidated open surgery technique.     

Severe intraoperative complications during VATS Lobectomy compared with thoracotomy lobectomy for early stage non-small cell lung cancer

Background

Video-assisted thoracic surgery (VATS) lobectomy has been proved to have shorter hospital stay, less perioperative complications and less pain compared with lobectomy by thoracotomy, but severe intraoperative complications during VATS lobectomy is rare reported. We compared intraoperative safety between VATS lobectomy and lobectomy by thoracotomy.

Methods

659 patients with postoperative stage I and IIa non-small cell lung cancer (NSCLC) who underwent lobectomy in China-Japan Friendship Hospital from February 2008 to June 2012 were analyzed retrospectively, in which 277 were performed by thoracotomy, 357 performed by VATS, and 25 performed by VATS converted to open. Outcomes were analyzed to compare the incidence of significant bleeding, with conversion cases were included into VATS group.

Results

Ten severe intraoperative complications were identified in 10 patients (6 in VATS, 4 in open), with no intraoperative deaths. The incidence of severe intraoperative complications was similar between VATS group and thoracotomy group [1.57% (6/382) vs. 1.44% (4/277), P=1.0]. Most severe intraoperative complications were related to the injury of major pulmonary vessels (9/10), and most of these complications occurred during upper lobectomy (8/10). There was no statistically significant difference in blood loss (242.85±220.47 vs. 240.43±144.36, P=0.865), and operative time (198.00±75.24 vs. 208.05±61.97, P=0.061) between the open and VATS groups, respectively, but blood loss and operative time are significant different after elimination of conversion cases (214.34±151.85 vs. 240.43±144.36, P<0.01; 193.24±72.64 vs. 208.05±61.97, P<0.01).

Conclusions

Our preliminary study demonstrated that the incidence of severe intraoperative complication during VATS lobectomy was low and similar to open lobectomy. The severe intraoperative complications during VATS lobectomy are manageable and the surgeons need to take proper caution in performing VATS lobectomy.KEY WORDS : Lung cancer surgery, lobectomy, bleeding, surgery complications     

Endovascular vs. open surgery of abdominal aortic aneurysm in high-risk patients: a single center experience

BACKGROUND: We compared two groups of high-risk patients with abdominal aortic aneurysm to assess the safety and efficacy of endovascular repair vs. open surgery. METHODS: From January 1998 to July 2003, sixty-two high-risk patients were divided into two groups: group A consisted of 28 (46 %) open surgery patients and group B consisted of 34 (54 %) patients who underwent endovascular repair. RESULTS: Four patients (14.3 %) in the open surgery group died, while no deaths occurred in the endovascular group ( p < 0.05). There were 14 complications in 8 patients of the open surgery group versus 2 complications in 2 patients of the endovascular group ( p = 0.01). At follow-up there were 4 (16.6 %) deaths in group A and 3 (8.8 %) in the endovascular group ( p = n. s.). CONCLUSIONS: While the use of endovascular repair in patients who are physiologically fit for open surgical repair remains controversial, we believe that patients with multiple or advanced comorbidities, i.e. high-risk patients, can benefit from the endografting procedure.     

Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: a review of the Mayo Clinic experience

Background There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)‐dependent Cushing's syndrome continues to be defined. Objective Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH‐dependent Cushing's syndrome. Design Retrospective review study. Patients Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH‐dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary‐dependent Cushing's syndrome following pituitary surgery). Measurements Review of peri‐operative morbidity and mortality, biochemical parameters and patient‐reported symptom response from chart review and mailed questionnaire. Results BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra‐operative complications occurred in three patients (4·4%) (two BLA, one OA), and non‐operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri‐operative deaths. Median hospitalization was 5·5 days (range, 3–28) and 11·9 days (range, 4–29) for the BLA and OA groups, respectively. In patients with follow‐up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. Conclusions This study further supports the role of BLA as an effective treatment option for patients with ACTH‐dependent Cushing's syndrome.     

儿童开腹与腹腔镜食管裂孔疝修补＋胃底折叠术的疗效比较

目的比较儿童开腹与腹腔镜食管裂孔疝（HH）修补+胃底折叠术的疗效及安全性。 方法回顾性分析2008年1月至2018年1月新疆维吾尔自治区人民医院收治的经上消化道造影检查诊断为HH的42例患儿。其中20例行开腹HH修补＋胃底折叠术（开腹手术组）,22例行腹腔镜HH修补＋胃底折叠术（腹腔镜手术组）。记录并比较2组患儿的切口长度、手术时间、术中出血量、术后进食时间、术后住院时间,同时观察2组患儿术后疼痛及并发症发生情况,并比较2组患儿术后并发症发生率。 结果腹腔镜手术组患儿切口长度短于开腹手术组患儿［（2.2±0.3）cm vs （7.5±1.1）cm］,且差异有统计学意义（t=20.833,P<0.05）;但2组患儿手术时间、术中出血量差异均无统计学意义［（115.4± 20.5）min vs （104.2±18.6）min,（2.9±0.3）ml vs （3.1±0.5）ml,t=1.552、1.857,P均>0.05］。腹腔镜手术组患儿术后进食时间、术后住院时间均短于开腹手术组患儿［（1.3±0.3）d vs （2.2±0.4）d,（5.2±1.6）d vs （9.3±1.1）d］,且差异均有统计学意义（t=8.182、9.753,P均<0.05）。2组患儿术后并发症发生率差异无统计学意义［9.1% （2/22）vs 5.0% （1/20）,χ²=0.264,P>0.05］。开腹与腹腔镜HH修补＋胃底折叠术均为小儿HH安全、有效的治疗方法。与开腹手术比较,腹腔镜手术术后禁食时间短,术后恢复快,更美观。