小切口胆囊切除术临床应用体会

本文报道了作者于１９９４年－１９９６年期间对胆囊良性病变实施小切口胆囊切除术１３６例的情况，并与传统的胆囊切除术做了比较，。通过地结果的分析表明；小切口胆囊切除术是一种创伤小、恢复快、并发症少的安全术式，具有较好的临床疗效，作者还对实施小切口胆主需注意的问题和诮具备的相关条件及手术操作体会作了阐述。     

小切口胆囊切除术的临床应用

开腹胆囊切除术自1882年实施以来，被证明为安全有效的手术方式。目前胆囊切除术主要采用传统手术、小切口手术(MC)及腹腔镜手术3种方式。1982年法国Dubois曾介绍过小切口胆囊切除术，但未能引起外科界重视，1987年Jean Mouret首次用腹腔镜胆囊切除术(LC)后，小切口胆囊切除术才引起人们关注。我院自1998年1月-2004年1月间共实施小切口胆囊切除术268例，现总结经验报告如下。     

小切口胆囊切除术(附106例报告)

作者认为腹腔镜胆囊切除术并非较理想的方法.综合了传统胆囊切除术和腹腔镜胆囊切除术的优缺点,倡用小切口胆囊切除术,成功地实施了106例.     

小切口胆囊切除术复杂情况的处理

目的 总结小切口胆囊切除术的临床经验。探讨小切口胆囊切除术中复杂情况的处理方法及手术安全性。方法 回顾性分析我院2002年1月～2007年6月行小切口胆囊切除术患者的临床资料。结果 全组136例，131例成功行小切口胆囊切除术，5例延长切口完成手术，全部治愈出院，无并发症发生。结论 对于复杂情况的胆囊炎患者，只要方法得当，小切口胆囊切除术仍是一种安全有效的手术方法。     

小切口胆囊切除术50例疗效分析

目的总结小切口胆囊切除术的疗效。方法2007年1月至2008年12月我院选择性施行小切口胆囊切除术50例，对其临床资料进行回顾性分析。结果术后并发症：切口感染1例，切口脂肪液化1例，粘连性肠梗阻1例，胆瘘1例，经对症处理痊愈出院。结论小切口胆囊切除术具有腹腔镜切除术的创伤小、痛苦少、恢复快等优点，值得推广。     

侧翼式窄拉钩小切口胆囊切除术

侧翼式窄拉钩小切口胆囊切除术乔建国尹玉春曹军自１９９５年６月开始，作者用自行设计的侧翼式窄拉钩施行小切口胆囊切除术，并摸索出相应的操作方法。经９例临床应用，作者体会该法不仅减少手术创伤，而且具有显露满意、操作简便的特点，介绍如下。１侧翼拉钩左侧和下方...     

小切口胆囊切除术100例总结

小切口胆囊切除术１００例总结西安铁路分局洛阳医院（７２４３００）李代军通常胆囊切除术切口较长、损伤组织多，病人痛苦重。腹腔镜胆囊切除术设备昂贵，操作技术要求高，基层医院难以普及。我院从１９９１年１月至１９９３年１２月行胆囊切除术２４８例，其中行小切口...     

小切口胆囊切除术800例体会

小切口胆囊切除术（MC）是近年微创外科技术在胆囊切除术的应用方法之一。它与腹腔镜胆囊切除术（LC）和常规胆囊切除术成为胆囊切除的主要方法，被认为均为安全的术式。1995年3月～2004年11月我院选择性施行小切口胆囊切除术800例，效果满意，现将体会报告如下。     

微小切口胆囊切除术2260例效果观察

目的 总结微小切口胆囊切除术治疗胆道系统疾病的经验。方法 对2002-2004年连续收治的2260例胆囊、胆道系统疾病实施微小切口手术的临床观察资料进行回顾性分析。结果 本组2260例微小切口胆囊切除术的患者无一例因手术原因死亡；术后无残留小胆囊；无胆汁漏及腹腔脓肿，亦无伤口全层裂开及切口疝形成。结论 该术式损伤小、局部显露清楚、不易发生副损伤，可同时行胆总管探查术，特殊情况下可随时改变手术方式。     

小横切口胆囊切除术

小横切口胆囊切除术又称微小创伤性胆囊切除术，是一种改良的剖腹胆囊切除术。该手术损伤小，患者术后恢复快，疼痛轻，无需昂贵的医疗器械及人员培训，可达到与传统胆囊切除术及腹腔镜胆囊切除术同样安全的效果。作者设计的“小横切口”即在右上腹肋缘内侧第八肋水平做一４－６ｃｍ长的横切口，在直视下逆行切除胆囊。     

老年人腹腔镜胆囊切除术的临床应用体会

目的总结老年人腹腔镜胆囊切除术(LC)的经验。方法对1991年3月至2005年6月间,60岁以上老年人 LC2986例临床资料进行回顾性分析。结果慢性结石性胆囊炎2698例,胆囊息肉108例,急性胆囊炎80例。中转开腹48例, 其余2938例均经LC治愈(占98．39％)。本组术后24小时均恢复肠蠕动,术后第1天能进流食及下床活动,术后住院时间3- 7天。结论 LC安全可靠,更适合于老年病人。严格掌握手术适应证和禁忌证,充分的围手术期处理,熟练的手术操作是成功的关键。     

Cholecystectomy in morbidly obese patients

Indications for performing cholecystectomy simultaneously with a gastric bariatric operation remain controversial. The extremes are to always perform cholecystectomy or to perform cholecystectomy only when there are palpable stones or the gallbladder is grossly diseased. Since 1975, 136 cholecystectomies have been performed simultaneously in 724 patients who had a gastric bariatric operation. Cholecystectomy had been performed before the bariatric operation in 120 and was required later in 18 patients. The clinical records, anesthesia, pathology, and operative reports provide the data for this study. Simultaneous cholecystectomy was done through the vertical midline incision used for gastric bariatric operation. No patients had the gallbladder bed closed or were drained. Operative cholangiogram were not performed because this procedure would have been difficult and significantly prolonged because of the obesity. No patients have developed postoperative choledocholithiasis. One patient developed a complication related to cholecystectomy, a common bile duct stricture. The length of the operation and the postoperative hospitalization with and without simultaneous cholecystectomy were compared. The results of intraoperative ultrasound studies performed upon these patients are described and discussed. It is concluded that cholecystectomy should be performed simultaneously with all gastric bariatric operations when there is gross or echogenic evidence of gallbladder disease. Cholecystectomy does not significantly prolong or complicate the gastric bariatric operation.     

Acute suppurative cholecystitis: a retrospective study of 173 cases.

Over a 14-year period we treated 2,290 cases of non-malignant biliary tract conditions, and among them were 173 cases of acute suppurative cholecystitis, an incidence of 7.6%. A correct preoperative diagnosis of acute suppurative cholecystitis was made in only about half the cases because features of recurrent pyogenic cholangitis dominated the clinical picture on many occasions. The diagnosis was confirmed in all cases at operation. Cholecystectomy (88%) was performed whenever this was found to be safe, and cholecystostomy (12%) was carried out only in poor-risk patients or when operative difficulties were encountered. The overall mortality of operation was 5.8%. Old age, preoperative shock, delay of operation and the presence of free perforation affected the prognosis adversely.     

Surgical tactics in acute cholecystitis in old patients]

Based on some characteristic features of the clinical course of acute cholecystitis and large number of its destructive forms in aged persons, it is recommended to operate patients of this group during 24-28 hours after their admission. 216 aged and senile patients with acute cholecystitis were operated upon, the postoperative mortality being 9.7%. Cholecystectomy is considered to be the operation of choice. In the appropriate indications this operation was associated with drainage of the common bile duct. Cholecystostomy was performed in 10.6%.     

胆道感染性休克的治疗(附405例分析)

目的评价各种治疗手段对胆道感染性休克治疗的结果.方法回顾性分析1981年7月～1999年5月间收治胆道感染性休克405例.结果手术治疗302例,治愈267例,治愈率88.4%,死亡35例,病死率11.6%;非手术治疗103例,治愈61例,治愈率59.2%,死亡42例,病死率40.8%.手术治疗效果优于非手术治疗(P<0.01).术前或术后6h内纠正休克效果好(P<0.01).胆囊切除比未切除效果好(P<0.01).结论应尽快纠正休克并及时施行手术.应常规切除胆囊以利术野暴露,清除原发病灶及毒素源.胆肠吻合术并非禁忌证.     

Wound dehiscence after cholecystectomy and salmonella infection.

A case of a wound dehiscence following a Salmonella wound infection is reported. Cholecystectomy for the typhoid carrier state is not an uncommon operation and carries the risk of Salmonella wound infection in about 7 per cent of the cases. Wound dehiscence with this type of infection has not previously been reported.     

ACUTE SUPPURATIVE CHOLESYSTITIS: A RETROSPECTIVE STUDY OF 173 CASES

Over a 14-year period we treated 2,290 cases of non-malignant biliary tract conditions, and among them were 173 cases of acute suppurative cholecystitis, an incidence of 7.6%. A correct preoperative diagnosis of acute suppurative cholecystitis was made in only about half the cases because features of recurrent pyogenic cholangitis dominated the clinical picture on many occasions. The diagnosis was confirmed in all cases at operation. Cholecystectomy (88%) was performed whenever this was found to be safe, and cholecystostomy (12%) was carried out only in poor-risk patients or when operative difficulties were encountered. The overall mortality of operation was 5.8%. Old age, preoperative shock, delay of operation and the presence of free perforation affected the prognosis adversely.     

Mirizzi�ۺ���������̽��

目的 探讨Mirizzi综合征的诊断及外科手术治疗的术式。方法 回顾性总结分析28例Mirizzi综合征病的临床资料。结果 28例病人分别行胆囊切除或部分胆囊切除，直接瘘口修补或胆囊补片修补及Rouxen-Y 式肝总管十二指肠吻合术或空肠吻合术。所有病人均痊愈出院。结论 术前明确诊断可减少Mirizzi综合征术中胆道损伤的发生率，手术方式依据病理分型而定。内镜逆行性胰胆管造影（ERCP）及B超是术前明确诊断的主要手段。     

Cholecystectomy under celioscopy

Cholecystectomy which is the best treatment for gallstones can be performed via laparoscopy in cases of uncomplicated stones. Thirty patients have been operated upon by this technique. The advantages are: small scars, easy recovery and short hospital stay. Nevertheless there are some risks, particularly hemorragic and traumatic complications in the biliary tract, so that operation must be done by a surgeon trained in biliary surgery.     

Impact of choice of therapeutic strategy for acute cholecystitis on patient's health-related quality of life. Results of a randomized, controlled clinical trial

BACKGROUND: The aim of this prospective, randomized study was to determine if health related quality of life is affected by the choice of surgical strategy in the management of acute cholecystitis. MATERIAL AND METHODS: After diagnostic workup, patients were randomized to one of two groups: (1) early laparoscopic cholecystectomy (i.e. within 7 days after onset of symptoms) or (2) initial conservative treatment followed by delayed laparoscopic cholecystectomy. Seventy-four patients entered the early operation group and 71 patients were assigned to the delayed operation strategy. Assessments of quality of life were made at 1, 3 and 6 months after surgery, and in the delayed operation group also one month after the initial conservative treatment. RESULTS: The gastrointestinal symptom scores were significantly better in three dimensions (diarrhea, indigestion, abdominal pain) one month after surgery for the acute operation group (p < 0.01). Three and 6 months after the operation we were unable to detect any significant differences between the groups. The patients in the delayed operation group did not appear to suffer from more symptoms in the period of time waiting for their elective operation. Psychological general well-being showed no major differences between the groups. CONCLUSION: Cholecystectomy in the acute phase of acute cholecystitis offers a significant reduction of gastrointestinal symptoms during the first postoperative month and to that associated improved quality of life in this group of patients.