逆行胆囊切除术在腹腔镜胆囊切除术中的应用研究

目的：研究逆行胆囊切除术在腹腔镜胆囊切除术中的应用效果。方法选取我院在2011年1月~2013年12月收治的46例由于胆囊三角区结构模糊不容易进行分离,从而把进行逆行切除胆囊手术的患者作为研究对象,根据入院的次序将其分为两组。即对照组和观察组,对照组患者采用腹腔镜顺行胆囊切除术,而观察组患者采用逆行胆囊切除术,对比两种治疗方法的治疗效果。结果两组患者在手术时间、术中转开腹手术患者等方面,观察组均优于对照组,两组数据差异比较具有统计学意义,<0.05。结论在进行胆囊切除手术中对于胆囊三角区模糊的患者采用逆行腹腔镜胆囊切除术更加安全可靠,治疗效果非常好,值得在临床上大力推广。     

腹腔镜下胆囊切除术96例的临床分析

目的：探讨腹腔镜胆囊切除术(LC)的临床治疗效果及其并发症的预防。方法回顾分析我院2013年3月~2014年6月96例胆囊结石患者的临床资料,全部患者均在腹腔镜下行胆囊切除术。结果本组96例均顺利完成胆囊切除,平均手术时间40min(24~70min);术后平均住院4d(3~5.5d)。术中出现并发症6例,均未采取特殊处理,对症治疗后无严重后遗症发生。结论腹腔镜胆囊切除术具有手术时间短、创伤小、粘连少、痛苦轻、恢复快、术后瘢痕小等优点,值得推广,但仍然存有并发症;因此应严格遵循手术原则,并规范手术操作以减少并发症,从而保证手术治疗效果。     

腹腔镜胆囊切除术的手术配合体会

腹腔镜胆囊切除术（LC）是一项外科新技术，它同传统的开放性术式相比，具有创伤小、恢复快、切口小等优点，良好的护理配合是该手术的成败及患者术后顺利康复的重要环节。我院2003年6月至2006年2月采用腹腔镜进行胆囊切除术184例患者，现将手术配合体会报告如下。     

腹腔镜胆囊切除术对胆结石治疗效果的分析

目的分析腹腔镜胆囊切除术对胆结石的治疗效果。方法选取2012年1月~12月在我院接受治疗的胆结石患者80例,随机分为实验组与对照组。实验组患者40例,给予腹腔镜胆囊切除术进行治疗;对照组患者40例,给予传统的开腹手术进行治疗。比较两组患者的治疗效果、手术时长、住院时长、术后并发症的发生情况等。对腹腔镜胆囊切除术治疗胆结石的效果进行判定。结果两组患者手术均顺利实施。相比之下,实验组患者的康复情况优于对照组患者,其中,实验组患者的平均手术时长为(40.5±5.5)min、对照组患者的平均手术时长为(60.0±8.5)min;实验组患者的平均住院时长为(5.5±1.5)d、对照组患者的平均住院时长为(8.5±3.5)d;实验组患者的术后并发症发生率为6.0%、对照组患者的术后并发症发生率为13.5%。两组数据差异显著,结果具有统计意义(P<0.05)。结论腹腔镜胆囊切除术对胆结石具有较好的临床治疗效果,该手术法手术时长短,术后患者恢复快,并发症发生较少,值得在临床上广泛推广。     

常规器械经脐单孔腹腔镜胆囊切除术的临床应用

目的:探讨常规腹腔镜器械经脐单孔腹腔镜胆囊切除术的安全性及临床效果.方法:回顾分析我院2010年11月~2011年8月间开展腹腔镜胆囊切除术213例患者的临床资料,将其中使用常规腹腔镜器械经脐单孔腹腔镜胆囊切除术的61例患者作为 A组,使用传统腹腔镜胆囊切除术的152例作为 B组,对比两组手术时间、术中出血量、手术并发症、术后疼痛程度、术后进食时间、下床活动时间、住院时间及住院总费用等指标.结果:两组均痊愈出院,无出血、胆漏、胆管损伤等并发症发生.术中出血量及并发症,术后进食时间,下床活动时间两组无差异(P>0.05);但 A组术后疼痛较轻,住院时间及住院总费用低于 B组(P<0.05).结论:只要适应证选择恰当,使用常规腹腔镜器械经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术一样安全可行,美容效果及病人的心理满意度较好.     

胆囊炎开腹胆囊切除术与腹腔镜胆囊切除术疗效比较

目的 比较胆囊炎开腹胆囊切除与腹腔镜胆囊切除术的临床疗效.方法 将80例急性胆囊炎患者分成腹腔镜组和开腹手术组各40例,比较两组患者的手术效果.结果 两组均顺利完成手术,腹腔镜组无中转开腹者.两组手术效果比较显示,腹腔镜组的手术时间短、术中出血量少,肛门排气时间早,住院时间短,且并发症发生率低,与开腹组比较,差异均有统计学意义(P<0.05).结论 腹腔镜胆囊切除术具有创伤性小、并发症少及住院时间短等优点,手术效果明显优于传统开腹胆囊切除术,值得临床推广.     

126例腹腔镜胆囊切除术的护理体会

目的探讨腹腔镜胆囊切除术的护理措施及疗效。方法对我院126例行腹腔镜胆囊切除患者的临床资料、护理措施及护理效果进行回顾性分析。结果 126例行腹腔镜胆囊切除患者手术时间平均为45min;术中出血少,术后生命体征平稳,部分患者出现皮下气肿和呕吐;患者平均住院5d,均痊愈出院,术后恢复良好,生活工作正常。结论做好患者术前、术后护理和出院指导,是保证患者手术成功、早日康复的重要前提。     

腹腔镜胆囊切除术中电凝法处理胆囊动脉的临床应用

目的总结腹腔镜胆囊切除术中用电凝处理胆囊动脉的效果。方法回顾性分析2000~2006年86例腹腔镜胆囊切除术中电凝法处理胆囊动脉的临床资料。结果电凝法85例(98.8%)术中、术后无继发出血;1例因胆囊动脉封闭不牢固需要用夹闭法。平均手术时间38min(20~70min)。术中平均出血量11ml(5~30ml)。术后平均住院时间3d(1~5d)。无手术并发症发生。结论腹腔镜胆囊切除术中合理应用电凝法处理胆囊动脉止血效果可靠,节省费用。     

腹腔镜胆囊阑尾联合切除术42例临床分析

目的：探讨腹腔镜胆囊阑尾联合切除术临床价值。方法回顾性分析2006年6月~2011年10月我院42例腹腔镜胆囊阑尾联合切除术患者的临床资料,全麻下先行腹腔镜胆囊切除术,然后调换进镜孔和主操作孔位置,再行腹腔镜阑尾切除术。结果42例腹腔镜胆囊阑尾联合切除手术均获成功,无中转开腹,手术时间40~105min,平均(65.0±10.5)min,无1例并发症发生。结论腹腔镜胆囊切除联合阑尾切除术将需分两次进行的上、下腹手术简化为一次微创手术解决,具有创伤小,并发症少,恢复快的特点,值得临床推广应用。     

老年急性胆囊炎腹腔镜胆囊切除术的手术护理配合

目的探讨老年急性胆囊炎腹腔镜胆囊切除术的手术护理配合。方法对于我院治疗的118例老年急性胆囊炎腹腔镜胆囊切除术的患者采取手术护理配合措施,对临床护理效果进行观察。结果全部患者采取护理配合措施后手术均顺利完成,所有患者平均手术时间为(43.2士18.7)min,所有患者的平均住院时间为(3.9士1.8)d,期间未发生中转开腹病例。结论对老年急性胆囊炎患者腹腔镜胆囊切除术采取手术护理配合措施可提高患者的预后,有效降低术后并发症的发生率,值得临床推广。     

Bulldog夹在三孔法腹腔镜保胆取石术中的应用分析

目的 探讨Bulldog夹在三孔法腹腔镜保胆石取石术中的应用价值。方法 回顾2014年7月~2016年 8月华中科技大学同济医学院附属中西医结合医院接受三孔法腹腔镜保胆取石术病例36例,术中均于胆道镜取石操作前采用Bulldog夹临时阻断胆囊管,观察并记录结石标本的性状、分布和数量,检测术后肝功能及炎症反应情况,并对手术前后胆囊声像学表现进行评估。结果 所有36例患者均顺利完成手术操作,其中小胆石者（<0.3 cm）占22.22%,胆色素结石者占52.78%,胆道镜证实胆囊管结石者为13.89%。术后第3天,观察组平均TBIL、DBIL、ALP均处于正常范围内,PCT及CRP水平亦未超过正常值上限;与术前相比,术后2月彩超复查胆囊壁厚度（2.37±1.42 mm vs 2.25±0.72 mm）,无统计学差异(P>0.05),且未发现胆囊腔内残石及胆管扩张病例。结论 Bulldog钳可以作为安全有效的胆囊管暂时阻断器械应用于GPLC术中,在提高胆囊管结石清除率的同时,有效防止胆石溢入胆总管,且不会增加术后胆囊炎、胆囊动脉损伤风险。     

3种胆囊床止血方法在腹腔镜胆囊切除术中应用效果比较

目的:观察腹腔镜下胆囊切除术（LC）中不同胆囊床止血方法的临床效果。方法:随机选取120例择期行腹腔镜下胆囊切除术患者,按照胆囊床止血方式不同分为3组:局部电凝组、全电凝组及生物纸组,比较3组患者术后2、12、24、48 h腹腔累积引流量,并在术前及术后24、72 h检测患者肝功能指标。结果:生物纸组各时间段累计腹腔引流平均量均少于其他两组（P<0.05）,各组组内术后24 h生化指标较术前显著升高（P<0.05）,各组间术后24 h生化指标比较无统计学差异（P>0.05）。结论:腹腔镜下胆囊切除术中应用生物纸处理胆囊床能够有效预防创面出血及渗出,同时具有较好的生物安全性,对人体无不良影响。     

Relationship between weight loss and gallbladder motility in obese women

OBJECTIVE AND AIM: Most studies have detected impairment of gallbladder motility among obese compared with nonobese people. However, the relationship between gallbladder motility and weight loss is not well defined. The aim of this study was to evaluate the relationship between percent of weight loss and gallbladder motility during weight-reducing programs in obese women. PATIENTS AND METHODS: Thirty-four premenopausal obese women (body mass index >30 kg/m2) were included in the study. Following an overnight fast, fasting and postprandial 15-, 30-, 45-, 60-, 75-, 90-, 120- and 150th-minute gallbladder volumes and ejection fractions were evaluated with real-time ultrasonography as baseline and repeated after sixth months of weight-reducing programs. The lowest postprandial gallbladder volume was accepted as the residual volume. Gallstone formation was found in three (8.8%) patients during the study period, and these patients were dropped out. Thirty-one obese women were divided into three groups based on weight loss percent (group 1: 11 patients, weight loss <5%; group 2: 10 patients, weight loss 5-10%; group 3: 10 patients, weight loss >10%). RESULTS: Fasting gallbladder volume and all ejection fractions were not significantly different between baseline and after sixth months in all groups (p>0.05). Residual volume was decreased after sixth months in only group 3 (p=0.005). Difference of fasting and residual volumes, and ejection fractions at baseline and after sixth months was similar in all groups (p>0.05). There was a positive correlation between weight loss and the change of residual volume (r=0.395, p=0.028). CONCLUSION: Our findings suggest no relationship between degree of weight loss and ejection fraction. However, decreased residual volume and late-phase gallbladder volumes indicate gallbladder motility changing in patients who had >10% weight loss.     

Postoperative extracorporeal life support in pediatric cardiac surgery: recent results

We retrospectively reviewed the files of 19 extracorporeal life support (ECLS) applications performed after cardiac surgery in 15 patients from January 2002 to December 2004. We placed 16 arteriovenous ECLS applications with oxygenator, 2 venovenous ECLS applications with oxygenator, and 1 biventricular ECLS application without oxygenator (graft dysfunction after heart transplant). Mean age was 4.9 +/- 7 years (median 5.9 months, range 11 days to 21 years). All patients underwent surgery for congenital heart disease, except for one patient who had a heart transplant. Indications were hemodynamic failure in 12 cases, respiratory failure in 5 cases, and mixed failure in 2 cases. Four patients were undergoing cardiopulmonary resuscitation during ECLS placement (no deaths). Mean delay between surgery and ECLS placement was 3.2 +/- 3.4 days (median 2 days). Mean ECLS duration was 3.4 +/- 5.8 days (mean 6 days, range 3-16 days). Three patients had further surgery for residual lesions. Thirteen patients (86.7%) survived to ECLS weaning; 12 patients survived to hospital discharge (80%). No survivor presented obvious neurologic damage. Specific morbidity included reentry for bleeding, multiple transfusions, and mediastinitis. These results support early placement of ECLS in children whenever a severe postoperative hemodynamic or respiratory failure, refractory to medical treatment, is present.     

粘蛋白在胆固醇结石和胆囊息肉胆囊组织中的表达和分泌差异

目的：研究粘蛋白（ mucin, Muc）在胆囊胆固醇结石和胆囊息内胆囊组织中的表达和分泌差异。方法纳入2010年6月至2015年6月在我院行胆囊切除术患者117为研究对象,其中单纯胆囊胆固醇结石患者78例,胆囊息肉患者39例,分析和比较两组患者胆囊组织中粘蛋白mRNA的相对表达水平,以及胆汁中粘蛋白的浓度,并进一步分析两者间的相关性。结果胆固醇结石患者胆囊组织中Muc1、 Muc2、Muc5AC和Muc5B mRNA的相对表达水平均明显高于胆囊息肉患者,其差异均具有统计学意义（P＜0．05）。而胆固醇结石患者胆囊组织中Muc3 mRNA的相对表达水平明显低于胆囊息肉患者,其差异具有统计学意义（P＜0．05）。另外,胆固醇结石患者胆汁中粘蛋白浓度明显高于胆囊息肉患者,其差异具有统计学意义（P＜0．05）。结论粘蛋白参与了胆囊胆固醇结石的形成和发展,可以作为胆囊胆固醇结石的治疗靶点。     

Detection of circulating tumour DNA after neoadjuvant chemoradiotherapy in patients with locally advanced oesophageal cancer

Active surveillance instead of standard surgery after neoadjuvant chemoradiotherapy (nCRT) has been proposed for patients with oesophageal cancer. Circulating tumour DNA (ctDNA) may be used to facilitate selection of patients for surgery. We show that detection of ctDNA after nCRT seems highly suggestive of major residual disease. Tumour biopsies and blood samples were taken before, and 6 and 12 weeks after, nCRT. Biopsies were analysed with regular targeted next-generation sequencing (NGS). Circulating cell-free DNA (cfDNA) was analysed using targeted NGS with unique molecular identifiers and digital polymerase chain reaction. cfDNA mutations matching pre-treatment biopsy mutations confirmed the presence of ctDNA. In total, 31 patients were included, of whom 24 had a biopsy mutation that was potentially detectable in cfDNA (77%). Pre-treatment ctDNA was detected in nine of 24 patients (38%), four of whom had incurable disease progression before surgery. Pre-treatment ctDNA detection had a sensitivity of 47% (95% CI 24–71) (8/17), specificity of 85% (95% CI 42–99) (6/7), positive predictive value (PPV) of 89% (95% CI 51–99) (8/9), and negative predictive value (NPV) of 40% (95% CI 17–67) (6/15) for detecting major residual disease (>10% residue in the resection specimen or progression before surgery). After nCRT, ctDNA was detected in three patients, two of whom had disease progression. Post-nCRT ctDNA detection had a sensitivity of 21% (95% CI 6–51) (3/14), specificity of 100% (95% CI 56–100) (7/7), PPV of 100% (95% CI 31–100) (3/3), and NPV of 39% (95% CI 18–64) (7/18) for detecting major residual disease. The addition of ctDNA to the current set of diagnostics did not lead to more patients being clinically identified with residual disease. These results indicate that pre-treatment and post-nCRT ctDNA detection may be useful in identifying patients at high risk of disease progression. The addition of ctDNA analysis to the current set of diagnostic modalities may not improve detection of residual disease after nCRT. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.     

Survival in women with ovarian cancer before and after the introduction of adjuvant paclitaxel; a 25-year, single institution review

Adjuvant chemotherapy regime for ovarian cancer patients remains to be a contentious issue. The aim of this study was to compare the overall and progression-free survival of women with ovarian cancer before and after introduction of paclitaxel in our unit in 1992. A sample of 112 women who received adjuvant therapy following surgery for ovarian cancer was collected, 68 (61%) received platinum+alkylating agent before 1992 and later 44 (39%) received platinum+paclitaxel. Five-year survival was same in both treatment groups when there was no macroscopic disease after surgery (78% versus 70%) and when residual disease was <2 cm (50% versus 40%). Survival was greater in women with residual disease >2 cm in the platinum+paclitaxel group (50% versus 24%), (p = 0.04). However, progression-free survival was similar in both groups irrespective of stage or residual volume of disease. Therefore consideration to selective use of paclitaxel could reduce patient morbidity and costs significantly.     

MRCP在腹腔镜胆囊切除术前对手术难易性评估的分析

目的对磁共振胆胰管成像(MRCP)在腹腔镜胆囊切除术(LC)手术前评估手术难易程度的效果进行分析。方法在我院2011年3月至2012年7月间收治的全部胆道疾病患者中,随机选择110例胆囊结石患者进行研究,全部病例均使用LC手术,术前进行MRCP检查。将真性胆囊息肉LC切除术的平均手术时间30 min作为评判标准,手术时间不超过30 min为正常手术,超过30 min为有一定难度的LC手术。对患者的年龄、性别、位置、胆囊体积、胆囊管的角度、胆囊壁厚度、胆囊周围的情况、胆囊管的长度、胆囊颈部是否存在结石等情况和LC手术难易程度的相关性进行分析。结果 LC手术的难易程度和患者胆囊管的长度、胆囊颈部是否存在结石有一定的相关性,和患者的年龄、性别、胆囊体积、位置、胆囊管的角度、胆囊壁厚度、胆囊周围的情况无相关性。结论在术前对患者进行常规MRCP检测,对LC手术难易程度的预测有着重要的指导意义。     

小切口治疗胆囊病变238例体会

目的评估小切口治疗胆囊病变的效果,探讨小切口治疗胆囊病变在基层医院的应用。方法采用回顾性资料,统计1995年1月至2006年12月利用小切口治疗的238例胆囊病变患者,观察手术时间、出血量、并发症发生率、术后下床活动、保留胃管及肛门排气时间和出院后随访情况。结果本组238例胆囊病变患者采用小切口切除胆囊,全部痊愈出院。手术时间、出血量、并发症发生率、术后下床活动、保留胃管及肛门排气时间均优于传统手术方法。结论小切口治疗胆囊病变操作简单,与常规手术比较,有创伤较小、手术时间较短、出血较少、患者术后恢复较快等特点。术后早期即可下床活动,胃肠减压时间及排气时间较常规手术短。     

一站式杂交手术与全弓置换治疗主动脉弓病变的疗效分析

目的探讨一站式杂交手术与全弓置换处理主动脉弓部病变的疗效。方法回顾性分析2017年1月至2019年4月我院收治的29例累及主动脉弓部病变患者的临床资料,将13例行一站式杂交手术的患者纳入杂交手术组,16例行全弓置换联合支架象鼻的患者纳入全弓置换组。比较2组患者肺部感染、胸腔积液、肾损伤、神经系统损伤、心功能不全、截瘫、切口感染、用血量和住院时间等情况。结果所有患者均成功完成手术。术后2组患者肺部感染、胸腔积液、一过性肾功能损伤、切口感染、一过性意识障碍、截瘫、脑梗死/脑出血、心功能不全、移植旁路血管再发狭窄、再发主动脉夹层等术后并发症发生率比较,差异无统计学意义(P>0.05);2组患者住院时间比较,差异无统计学意义(P>0.05);杂交手术组患者用血量平均(3.69±2.89)U,全弓置换组平均(12.38±3.14)U,组间比较差异有统计学意义(P<0.05)。杂交手术组围手术期因突发心跳骤停,成功复苏后脑死亡1例,全弓置换组无围手术期死亡病例。随访1~26个月,随访期间杂交手术组出现1例覆膜支架远端夹层扩张破裂死亡病例,全弓置换组出现1例脑血管意外导致呼吸功能衰竭死亡病例,其余患者恢复良好。结论一站式杂交手术与全弓置换治疗弓部病变效果均满意,其中一站式杂交手术用血量较全弓置换组明显减少,无需深低温停循环,对年龄大、一般情况差的患者更为有利;而全弓置换组用血量更大,需要停循环、创伤大,但象鼻支架材料利于二次手术根治远端病变,适用于年轻、术前一般情况良好的患者。