腹腔镜治疗胆囊息肉样病变切除117例体会

目的探讨腹腔镜治疗胆囊息肉样病变的临床疗效。方法回顾性分析117例患者行腹腔镜胆囊切除术及术中冰冻病理的临床资料。采用SPSS13．0统计软件进行数据分析,组间比较用X2检验,P〈0．05被认为有统计学意义。结果非肿瘤性息肉114例,多发,蒂细长,息肉直径以2—8mm为多见。肿瘤性息肉3例,均单发、宽蒂,息肉直径10～17mm。非肿瘤性息肉与肿瘤性息肉之间蒂宽、直径均有统计学意义（χ^=36．71、χ^2=17．79,P〈0．01）。结论腹腔镜胆囊切除联合术中快速病理对治疗单发、宽蒂、息肉直径〉10mm：合并结石的胆囊息肉样病变是安全、有效的。     

急性胆囊炎腹腔镜手术时机的选择

目的 :探讨腹腔镜治疗急性胆囊炎的最佳时机。方法 :14 1例急性胆囊炎患者。按照手术时患者的发病时间分为 2组 ,早期手术组 88例 ,起病 72h以内行腹腔镜胆囊切除术 (LC) ;晚期手术组 5 3例 ,起病72h后行LC。结果 :早期手术组 4例发生并发症 (4 5 5 % ) ,5例中转开腹 (5 6 8% )。晚期手术组 12例发生并发症 (2 2 6 4% ) ,9例中转开腹 (16 98% )。对比 2组并发症的发生率及术后恢复时间 ,早期手术组缩短了住院时间 ,节省了医疗费用。并且早期手术组无 1例发生严重并发症。结论 :急性胆囊炎一经诊断明确应立即行LC ,在炎症、粘连坏疽出现前行LC治疗急性胆囊炎是安全有效的     

保留胆囊动脉主干的腹腔镜胆囊切除术治疗急性胆囊炎的临床应用

目的:探讨保留胆囊动脉主干的腹腔镜胆囊切除术(LC)治疗急性胆囊炎的应用价值.方法:2018年5月至2020年5月共收治112例急性胆囊炎患者,随机分为观察组(n=58,行保留胆囊动脉主干的LC)与对照组(n=54,行常规夹闭胆囊动脉主干的LC),对比两组手术时间、术中出血量、胆漏发生率、住院时间、住院费用等相关指标....     

老年患者行腹腔镜胆囊切除术的临床体会

目的：探讨腹腔镜手术治疗老年患者胆囊疾病的可行性及手术方法。方法：回顾分析2005年6月至2007年11月我院38例老年胆囊疾病患者行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床资料。结果：38例手术均获成功,手术时间35~110min,平均50min,术后住院4~12d,平均7.6d。术后发生胆漏3例,均经引流自愈,未发生其他严重并发症。结论：老年患者行LC手术难度大,风险高,手术关键是把握手术时机,并具备高水平的腹腔镜手术技巧,加强围手术期的处理。     

复杂类型腹腔镜胆囊切除术576例分析

目的：总结复杂类型腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的经验,探讨复杂类型LC的安全性和临床特点。方法：回顾分析1993年6月至2009年12月为576例患者施行复杂类型LC的临床资料。结果：576例患者中,539例顺利实施LC,中转开腹37例,67例次发生不同情况的术后并发症,均治愈,无不良后果。结论：术前对手术难度充分评估、合理把握手术时机,术中精细操作、果断中转开腹是减少复杂类型LC并发症的前提;术后严密观察病情、积极处理并发症是避免后遗症的关键;复杂类型LC是安全可行的。     

腹腔镜困难胆囊切除的体会

目的 :探讨腹腔镜困难胆囊切除的方法 ,预防胆管损伤 (BDI)并发症的发生。方法 :回顾LC切除困难胆囊 2 71例的临床资料。结果 :困难胆囊切除 2 71例中 ,右肝管损伤 1例 ,肝总管部分夹闭 1例 ,胆囊管结扎成角 1例 ,胆囊床迷走胆管漏 1例 ,术后胰腺炎 1例 ,肝下积液 1例 ,戳孔感染 4例。行胆囊造瘘 2例 ,中转开腹 3例 ,放置引流管 31例。 3例胆管损伤再次开腹处理 ,胆管并发症为 1 1%。其它均保守治疗 ,术中发现经处理均痊愈。结论 :腹腔镜困难胆囊切除与术者的手术经验相关 ,既可多种方法并用 ,也可单用一种方法 ,要严格掌握适应证及中转手术的时机 ,合理使用器械 ,做好围术期的处理     

经脐单孔与常规腹腔镜胆囊切除术的对比研究

目的比较经脐单孔腹腔镜胆囊切除术（TUSPLC）与常规腹腔镜胆囊切除术（LC）的临床疗效。方法回顾性分析2010年5月至2010年10月确诊为无严重胆囊炎症的胆囊息肉或胆囊结石患者共56例,随机分为单孔组和常规组,比较两组手术时间、术中出血量、术后镇痛、术后住院时间及术后并发症。结果单孔组26例患者23例顺利完成手术,3例中转改LC;常规组30例患者均顺利完成手术。单孔组与常规组手术时间分别为（52.45±10.84）min和（39.29±8.61）min（t=5.0601,P=0.0000）,术中出血量分别为（19.32±5.69）ml和（22.17±6.27）ml（t=1.7703,P=0.0823）;术后需镇痛分别为1例和6例（χ2=0.0702,P=0.7910）;术后住院时间分别为（2.52±1.37）d和（2.57±1.16）d（t=0.7396,P=0.4628）。除手术时间两组有明显差异外（P〈0.05）,余两组观察指标差异均无统计学意义（P〉0.05）。两组均无出血、胆漏、胆管损伤等并发症发生。结论经脐单孔腹腔镜胆囊切除术与常规腹腔镜胆囊切除术一样安全、可行,具有瘢痕不明显且隐避,术后患者疼痛轻、恢复快等优点,在胆囊切除中占有一席之地。但对患者技术和设备要求较高。     

胆囊疾患合并肝硬变行腹腔镜胆囊切除术的体会

目的:总结胆囊疾患合并肝硬变行腹腔镜胆囊切除术(LC)的经验。方法:切胆囊疾患合并肝硬变ll例行LC,观察肝硬变对手术的影响和术后恢复过程。结果:11例术后均恢复顺利,随访至2000年12月无并发症发生。结论:无症状的轻度肝硬变患者行LC治疗安全可靠;伴有门静脉高压症的患者,是LC的相对适应证。行LC治疗应慎重,并须认真做好围手术期处理。     

Metastatic lobular carcinoma of the breast found incidentally on pathology following cholecystectomy for chronic cholecystitis: A case report

BackgroundTraditional oncologic pattern of spread of breast cancer is metastasis to axillary lymph nodes, lung, liver and bone (Doval et al., 2006 [1]). Here we present a case of unknown synchronous breast cancer in a patient that was revealed on histopathologic assessment following elective cholecystectomy.Case summaryA 57 year old female presented for an elective laparoscopic cholecystectomy secondary to biliary colic. Histopathologic assessment of the gallbladder revealed metastatic adenocarcinoma with signet ring features, consistent with metastatic lobular carcinoma. The patient went on to have a complete oncologic workup that revealed invasive ductal carcinoma with components of high grade ductal carcinoma in situ in the left breast, lobular carcinoma in the right breast, and metastatic lobular carcinoma to left and right axillary lymph nodes as well as diffuse osseous metastatic disease.ConclusionsMetastatic disease to the gallbladder found incidentally on elective cholecystectomy is a rare presentation of synchronous breast cancer.     

腹腔镜治疗急性胆囊炎的体会

目的:探讨为急性胆囊炎患者行腹腔镜胆囊切除术(LC)的手术时机及处理方法。方法:回顾分析152例急性胆囊炎患者行LC的临床资料。结果:152例均无严重手术并发症发生,中转开腹4例,占2.63%(4/152)。152例中,27例胆囊周围及胆囊三角与周围组织广泛粘连,手术操作难度大,行胆囊大部分切除术,占17.1%(27/152)。122例术后放置腹腔引流管2~5d,平均3d,占83.5%(122/152)。患者均治愈出院。结论:急性胆囊炎患者可施行LC,且安全有效,熟练的镜下操作技巧,充分的围手术期处理,适当放宽中转开腹指征是手术成功的关键。     

两孔法腹腔镜胆囊切除术的改进

目的:探讨改良两孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术方法及应用价值.方法:回顾分析2010年11月至2011年8月为30例患者采用常规器械行改良两孔法LC的临床资料,并与同期30例三孔法LC患者进行对比分析,观察两组患者手术时间、出血量、住院时间、切口累计长度等指...     

LC术后胆囊病理学检查的临床意义

目的:通过452例LC术后胆囊病理学检查分析,探讨胆囊炎症与LC手术的关系。方法:将452例LC术后胆囊病理学检查结果与术前患者的临床表现、影像学诊断、血细胞检查及LC手术共同分析。结果:胆囊炎症的程度与术前临床表现、影像学诊断、血细胞检查及LC手术之间密切相关。结论:术前评估胆囊炎症有助于LC手术的安全性和避免并发症的发生。     

腹腔镜胆囊切除治疗坏疽性胆囊炎的体会

目的 :探讨腹腔镜胆囊切除 (LC)治疗坏疽性胆囊炎的手术技巧。方法 :随机将 5 0例坏疽性胆囊炎分为 2组 ,由同一组手术医师分别行LC及开放胆囊切除 (OC)。结果 :手术时间、术后腹腔引流量两组相似。LC组术后患者下床活动时间早 ,肠功能恢复快 ,住院时间短。两组均未发生肝外胆管损伤、胃肠道损伤、胆漏等严重并发症。LC组中转OC率为 12 % ,并发症为 4 % ;OC组并发症为 16 %。结论 :在具有丰富LC经验的医师操作下 ,用LC治疗坏疽性胆囊炎安全可行。     

胆囊缝线悬吊在腹腔镜胆囊切除中的应用体会

目的:探讨胆囊悬吊技术在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:回顾分析2005年7月至2012年7月为57例患者于LC术中采用胆囊悬吊法的临床资料。结果:56例顺利完成腹腔镜手术,1例中转开腹。手术时间25～150 min,平均(41.60±19.89)min;术后6～8 h即可下床活动,排气后或肠鸣音恢复后即可进食,术后住院2～5 d,平均(4.00±1.15)d。随访1～20个月,均无并发症发生。结论:LC术中应用胆囊悬吊技术利于胆囊管的显露与游离,降低了手术难度,缩短了手术时间,值得推广应用。     

腹腔镜胆囊大部切除治疗急性坏疽性胆囊炎的临床分析

目的 探讨腹腔镜胆囊大部切除治疗急性坏疽性胆囊炎的临床疗效.方法 回顾120例急性坏疽性胆囊炎患者实施腹腔镜胆囊大部切除术后、观察其疗效及并发症的发生率.结果 120例急性坏疽性胆囊炎患者均成功施行腹腔镜胆囊大部切除、手术成功率为100%.平均手术时间(60.2±29.2) min、平均住院时间4～7 d、平均引流管留置时间2～5 d.术后无并发症发生.除择期手术组与急诊手术组手术时间(35.0±10.0) min vs.(55.0±12.0) min两组差异有统计学意义,P<0.05外,其他无统计学意义.结论 腹腔镜胆囊大部切除术治疗急性坏疽性胆囊炎是安全、有效的方法之一.     

急性胆囊炎腹腔镜切除术式选择

目的 :探讨急性胆囊炎行腹腔镜胆囊切除术的安全性。方法 :腹腔镜对急性胆囊炎的治疗分别选择 :胆囊大部分切除、胆囊前壁切除、胆囊完整切除三种术式。结果 :顺利完成腹腔镜胆囊切除 2 32例 ,中转手术 4例。全组无死亡病例 ,无胆道损伤、大出血等严重并发症。结论 :随着腹腔镜胆囊切除术经验积累和器械完善 ,急性化脓、坏死性胆囊炎甚至胆囊穿孔已不再是腹腔镜胆囊切除的禁忌证 ,均可在急性炎症期完成腹腔镜胆囊切除术。     

腹腔镜胆囊切除术与直视微创胆囊切除术治疗胆囊疾患比较分析

目的:比较分析腹腔镜胆囊切除术(LC)与直视微创胆囊切除术(MPC)治疗胆囊疾患的疗效。方法:2002年以来对228例患者分别行LC及MPC。对两组术后疗效、手术时间、住院时间、恢复工作时间、并发症等进行全面分析。结果:随访2~18个月,两组患者胆囊疾病引起的临床症状消失,效果满意。在手术时间安全性、术后并发症等方面,LC明显优于MPC(P<0.05)。结论:从手术安全性、减少术中、术后并发症,减轻患者痛苦,提高患者生存质量考虑,LC是治疗胆囊疾患的首选术式。     

以胆囊排空障碍为特点的慢性非结石性胆囊炎的诊治分析:附42例

目的 探讨以胆囊排空障碍为特点的慢性非结石性胆囊炎的诊断方法与外科治疗.方法 选取昆明医学院第二附属医院2006年1月至2008年12月收治的慢性非结石性胆囊炎42例临床资料进行分析.将其分为腹腔镜胆囊切除术组20例,非手术治疗组22例,比较其疗效.结果 42例均通过临床症状、B超、胆囊收缩功能检查、纤维胃镜、磁共振胰胆管成像得以诊断;均存在胆囊排空障碍,其中腹腔镜胆囊切除术组,术后随访18例,未再出现临床症状,失访2例;非手术治疗组,随访21例,临床症状反复发作19例,失访1例.腹腔镜胆囊切除术效果明显优于非手术治疗(P＜0.05).结论 以胆囊排空障碍为特点的慢性非结石胆囊炎可以通过临床症状、胆囊收缩功能检查、MRCP得以诊断,治疗方法以腹腔镜胆囊切除术为佳.

Abstract：

Objective To investigate the diagnosis and surgical treatment of chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability. Methods The clinical data of 42 patients with chronic acalculous cholecystitis in our hospital from January 2006 to December 2008were analysed. The patients were grouped into two groups: laparoscopic cholecystectomy (LC) group in 20 and non-surgical group in 22. The patients' symptoms on follow-up in the two groups were compared. Results The 42 patients with chronic acalculous cholecystitis were diagnosed by symptoms,ultrasound, fatty meal gallbladder contractability studies under ultrasound, fiber optic gastroscopy and magnetic resonance cholangiopancreatography (MRCP). In all patients, there was a complete absence of gallbladder wall contractability. In the LC groups, 20 patients received LC. 18 patients were followed up, and there were no symptoms. Two patients were lost to follow up. In the non-surgical group, 22 patients received non-surgical treatment. In 21 patients who were followed up, 19 patients had symptoms. One patient was lost to follow up. There was a significant difference between the LC group and the non-surgical group (P＜0.05). Conclusions Chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability could be diagnosed by symptoms, ultrasound, fatty meal gallbladder contractability studies under untrasound, and MRCP. The optimal treatment of chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability is LC.     

Routine cholecystectomy is not mandatory during morbid obesity surgery

BACKGROUND: Controversy exists concerning the utility of routine cholecystectomy during bariatric surgery. We report our series of bariatric surgical procedures at our institution without concurrent cholecystectomy. METHODS: From October 2003 to August 2005, 621 morbidly obese patients underwent a weight loss operation. Preoperatively, each patient had undergone abdominal ultrasound (AUS) to evaluate for abnormal gallbladder findings. Patients with previous cholecystectomy were excluded. Symptomatic patients with AUS findings consistent with gallbladder disease underwent concomitant cholecystectomy and bariatric surgery. Asymptomatic patients, despite AUS findings, did not undergo cholecystectomy with their bariatric operation. A comparison between the preoperative AUS-positive and AUS-negative, asymptomatic patients after bariatric surgery was performed. RESULTS: Of the 621 patients who underwent bariatric surgery, 170 (27%) had undergone previous cholecystectomy and were excluded. Of the remaining 451 patients, 17 with positive AUS findings and symptoms underwent cholecystectomy during bariatric surgery. The range of follow-up was 4-25 months. Of the 451 patients, 324 were asymptomatic and had negative AUS findings and 102 were asymptomatic and had positive AUS findings for gallbladder abnormalities. Postoperatively, 29 asymptomatic/AUS-negative patients (9%) developed symptoms and had positive AUS findings. Nine asymptomatic patients with AUS positive findings (9%) developed symptoms. Finally, 38 patients (8.4%) went on to undergo elective cholecystectomy. These 2 groups were not signficantly different statistically. CONCLUSIONS: In this study, the development of symptomatic/AUS-positive gallbladder abnormalities was low after obesity surgery, suggesting that mandatory cholecystectomy is not required at bariatric surgery.     

Gallbladder cancer: surgical results after cholecystectomy in 25 patients with lamina propria invasion and 26 patients with muscular layer invasion

BACKGROUND/PURPOSE: It has been stated that simple cholecystectomy is sufficient treatment for all patients with pT1 gallbladder cancer. However, other authors note the necessity of carrying out extended surgery when there is muscular-layer involvement. METHODS: A consecutive series of gallbladder carcinomas with lamina propria or muscular layer invasion were analyzed. Between July 1982 and December 2000, 51 patients with pT1 gallbladder carcinomas were treated with simple cholecystectomy (group A, 25 patients with lamina propria-invasion; group B, 26 patients with muscular-layer invasion). Patients with intraepithelial carcinomas were excluded from the study. RESULTS: There were no differences between the groups in average age, sex ratios, association with other tumors, histologic type, malignancy grade, cholecystitis type, macroscopic aspects, lymph node status, or treatment applied. After an average of 6 years' follow-up, no patients in group A and nine patients (34.6%) in group B died due to gallbladder carcinoma. Cystic lymph nodes could be studied in five of these nine patients who relapsed, and the results were negative for metastasis. Lymphatic or venous invasion was observed in five of these nine patients. CONCLUSIONS: According to these results, cholecystectomy is not sufficient treatment for gallbladder carcinoma with muscular-layer invasion.