老年人免气腹腹腔镜胆囊切除术的应用体会

目的 探讨免气腹腹腔镜胆囊切除术治疗老年人胆囊结石的价值.方法 回顾性分析2007年11月至2009年4月间52例老年胆囊结石患者施行免气腹腹腔镜胆囊切除术的临床资料.结果 52例顺利完成免气腹腹腔镜胆囊切除术,无中转开腹.手术时间30~120 min,平均55.1 min.置腹腔引流管8例.2例发生肩痛.术后无出血、胆管损伤、心肺功能障碍的进一步加重.结论 加强围手术期处理,控制好合并症,老年患者行免气腹腹腔镜胆囊切除术是安全可行的,是较好的手术治疗方案.     

低压气腹腹腔镜胆囊切除术在高危胆囊结石患者中的应用

目的 探讨高危人群低压气腹下腹腔镜胆囊切除术的安全性。方法 回顾分析近3年来对72例高危人群低压气腹下用腹腔镜行胆囊切除术的临床资料。结果 72例中,因术中出血中转开腹1例,因粘连分离困难开腹2例,余均顺利完成手术,无手术并发症,无死亡。结论 高危人群合并胆囊结石选用腹腔镜行胆囊切除术是安全、有效、可靠的方法,术后并发症少。低压缓慢造气腹是行腹腔镜胆囊切除术成功的关键。     

肝硬化与腹腔镜胆囊切除术

本文对肝硬化与腹腔镜胆囊切除术的基础及应用现状和优缺点作一综述。揭示出腹腔镜胆囊切除术中气腹对硬变肝脏功能会产生损伤作用,其主要机理是入肝血流的减少。引起肝脏血流动力学改变的可能机制为直接的机械压力、心输出量的降低及神经内分泌的影响。肝硬变条件下腹腔镜胆囊切除术的优点在于解剖清晰、出血少,适应了部分肝硬变患者肝移植的要求;缺点是气腹会加重肝功能的损伤。完善的术前准备,合理的术中处理,悉心的术后护理是肝硬变条件下完成腹腔镜胆囊切除术的必备条件。     

腹腔镜胆囊切除术治疗胆囊结石嵌顿伴积脓52例体会

目的 探讨腹腔镜胆囊切除术治疗胆囊结石嵌顿伴积脓病人的可行性及手术方法.方法 对我院自1997年7月～2006年7月收治的胆囊结石嵌顿伴积脓行腹腔镜胆囊切除术的52例的临床资料进行回顾性分析.结果 本组手术全部成功,术后均放置引流.术后出现胆漏1例,经放置腹腔引流管充分引流后治愈.全组无术后出血、内脏损伤和胆道损伤等并发症发生.结论 对急性胆囊炎伴胆囊壶腹部结石嵌顿和胆囊积脓的病人行腹腔镜胆囊切除术是可行的,可获得良好效果.     

肝硬化病人胆囊结石的腹腔镜治疗体会

目的探讨腹腔镜治疗肝硬变病人胆囊结石的时机和可行性。方法回顾性分析1996年9月~2004年12月收治的采用腹腔镜治疗的58例合并有肝硬变的胆囊结石的临床资料。结果52例成功行腹腔镜胆囊切除术,6例中转开腹行胆囊切除术。全组病人均痊愈出院。结论术前要掌握适应证,腹腔镜是治疗合并肝硬变胆囊结石的良好选择。     

复杂类型胆囊结石腹腔镜胆囊切除术

目的 探讨复杂类型胆囊结石腹腔镜胆囊切除的可行性.方法 回顾350例复杂类型胆囊结石行腹腔镜胆囊切除术的临床资料,其中血吸虫肝硬变伴症状性胆囊结石135例,胆囊结石嵌顿并急性胆囊炎、胆源性胰腺炎177例,腹部手术史38例.对手术时间、出血量、住院时间及手术并发症进行回顾分析.结果 血吸虫肝硬变伴症状性胆囊结石,胆囊结石嵌顿并急性胆囊炎、胆源性胰腺炎,腹部手术史3组手术时间分别为63 min(45~250min),68 min(30~220min),45min(30~120min);出血量分别为15.6 ml(10~350ml),80ml(50~350ml),35 ml(25~80ml);住院时间分别为1.2 d(1~4 d),4.5 d(1~26d),3.5 d(1~6 d).中转手术共18例(占5.1%),血吸虫肝硬变伴症状性胆囊结石6例,急性胆囊炎及胆源性胰腺炎10例,经胆囊管总胆管造影及网篮取石失败2例;另有胆总管电凝伤致迟发性胆漏,通过非手术治疗鼻胆管引流后痊愈1例.结论 对复杂类型胆囊结石腹腔镜胆囊切除术,准确掌握手术适应证,采用正确的手术操作方法,是安全可行的.     

早期和延期腹腔镜胆囊切除术治疗胆囊结石性胰腺炎疗效分析

目的 探讨早期和延期腹腔镜胆囊切除术治疗胆囊结石所致急性胆源性胰腺炎的疗效及对病人术后肠道功能的影响.方法 2018年1月～2020年1月收治的胆囊结石性胰腺炎病人84例.根据病人发病距行腹腔镜胆囊切除术时间分为早期组(44例,48小时内手术)和延期组(40例,48小时后手术).比较两组手术相关指标、并发症情况、中转开...     

免气腹腹腔镜胆囊切除术的临床应用价值

目的探讨免气腹腹腔镜胆囊切除术的临床应用价值。方法回顾性分析2006年3月至2008年3月间38例免气腹腹腔镜胆囊切除术患者的临床资料。结果38例患者均顺利完成手术．手术成功率100％,无血管损伤、脏器穿孔、胆道损伤、胆漏或者中转开腹等并发症发生。8例患者术后出现右肩背酸痛,对症治疗好转。结论免气腹腹腔镜胆囊切除术扩大了腹腔镜胆囊手术的范围,避免了气腹对人体的影响,尤其是针对心肺功能不全的老年患者,有不可取代的作用,是值得推广的。建立手术空间牵拉膈肌可能是造成腹腔镜术后肩背疼痛的重要原因。     

免气腹三孔法腹腔镜胆囊切除术的探讨

目的:探讨硬膜外阻滞下免气腹三孔法腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)在临床上的应用。方法:回顾性分析2002年4月~2006年10月386例胆囊结石或胆囊息肉患者在连续硬膜外阻滞下施行免气腹腹腔镜胆囊切除术的临床资料。结果:386例中除5例中转手术外,381例均顺利完成LC。术后无酸中毒、肩痛、心肺功能的进一步损伤及其他并发症发生。结论:免气腹三孔法LC非常适用于心肺功能差、肾功能不全及肝硬化等不能耐受气腹的老年患者,手术费用降低,并发症发生率下降。     

手助腹腔镜脾切除术

目的　探讨手助腹腔镜脾切除术手术技术。　方法　用手助腹腔镜技术完成 5例腹腔镜脾切除术 ,其中原发性血小板减少性紫癜 (ITP) 3例 ,血吸虫性肝硬变、脾肿大及脾功能亢进伴胆囊结石2例。 3例行手助腹腔镜脾切除术 ;2例同时行腹腔镜胆囊切除与手助腹腔镜巨脾切除。　结果　 2h～ 5h完成手术 ,术中出血少。患者术后恢复顺利。　结论　手助腹腔镜脾切除术操作安全、手术时间短 ,并使腹腔镜切除较大脾脏成为可能。     

Changing management of gallstone disease during pregnancy

Background: Symptomatic gallstones may be problematic during pregnancy. The advisability of laparoscopic cholecystectomy (LC) is uncertain. The objective of this study is to define the natural history of gallstone disease during pregnancy and evaluate the safety of LC during pregnancy. Methods: Review of medical records of all pregnant patients with gallstone disease at the University of California, San Francisco, from 1980 to 1996. Results: Of approximately 29,750 deliveries, 47 (0.16%) patients were treated for gallstone disease, including biliary colic in 33, acute cholecystitis in 12, and pancreatitis in two. Conservative treatment was attempted in all patients but failed in 17 (36%) cases. Two patients required combined preterm Cesarean-section cholecystectomy and 10 required surgery in the early postpartum period for persistent symptoms. Seventeen patients required cholecystectomy during pregnancy for biliary colic (10), acute cholecystitis (six), and pancreatitis (one). Three patients were treated with open cholecystectomy. Fourteen patients underwent LC at a mean gestational age of 18.6 weeks, mean OR time of 74 min, and mean length of stay of 1.2 days. Hasson cannulation was utilized in 11 patients. Reduced-pressure pneumoperitoneum (6–10 mmHg) was used in seven patients. Prophylactic tocolytics were used in seven patients, with transient postoperative preterm labor observed in one. There were no open conversions, preterm deliveries, fetal loss, teratogenicity, or maternal morbidity. Conclusions: In past years, symptomatic gallstones during pregnancy were managed conservatively or with open cholecystectomy. LC is a feasible and safe method for treating severely symptomatic patients. Received: 3 April 1997/Accepted: 5 July 1997     

Laparoscopic Cholecystectomy in Patients With Cirrhosis of the Liver and Symptomatic Cholelithiasis

Background:

The indications and benefits of laparoscopic cholecystectomy (LC) in patients with liver cirrhosis and symptomatic cholelithiasis have not been satisfactorily documented. The aim of this study was to investigate its efficacy and safety in such patients.

Methods:

Medical records of 38 patients with liver cirrhosis (stages Child-Pugh A and B) who underwent LC were retrospectively reviewed. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay were investigated and compared with noncirrhotic patients'' parameters in our database.

Results:

Cirrhotic patients who underwent LC were older than noncirrhotic patients (P=0.021). Both the conversion rate (15.78%) and the duration of hospital stay were increased in the cirrhotic group, but without significant differences. Major complications occurred more often in the cirrhotic group (P=0.027), increasing morbidity; however, the mortality was zero.

Conclusions:

LC can be safely performed in Child-Pugh A and B cirrhotic patients with symptomatic gallstone disease, with acceptable complication and conversion rates. The increased risk for a major complication, however, demands more attention than usual.     

Laparoscopic Cholecystectomy in Cirrhotic Patients

Background and Objectives:

Gallstones are twice as common in cirrhotic patients as in the general population. Although laparoscopic cholecystectomy (LC) has become the gold standard for symptomatic gallstones, cirrhosis has been considered an absolute or relative contraindication. Many authors have reported on the safety of LC in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of LC in cirrhotic patients at a tertiary care hospital in Pakistan.

Methods:

From January 2003 to December 2005, a retrospective study was conducted at SU IV, Liaquat University of Medical & Health Sciences Jamshoro. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Cirrhosis was diagnosed based on clinical, biochemical, ultrasonography, and intraoperative findings of the nodular liver and histopathological study.

Results:

Of 250 patients undergoing laparoscopic cholecystectomy, 20 (12.5%) were cirrhotic. Of these 20, 12 (60%) were Childs group A and 8 (40%) were group B. Thirty percent were hepatitis B positive, and 70% were hepatitis C positive. Preoperative diagnosis of cirrhosis was possible in 80% of cases, and 20% were diagnosed during surgery. Morbidity rate was 15% and mortality rate was 0%. Two patients developed postoperative ascites, and mean hospital stay was 2.8±0.1 days. Of the 20 cases, 2 (10%) were converted to open cholecystectomy. The mean operation time was 70.2±32.54 minutes.

Conclusion:

Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in select patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the lower morbidity rate and reduced hospital stay.     

Systemic and cell-mediated immune response after laparoscopic and open cholecystectomy in patients with chronic liver disease. A randomized, prospective study

BACKGROUND: As impaired immune function observed in cirrhotic patients is known to increase the risk of postoperative complications, the immunological response to surgery was investigated. METHODS: Twenty-eight patients with postnecrotic liver cirrhosis or chronic hepatitis C and symptomatic gallstone disease were randomly allocated to laparoscopic (LC) or open cholecystectomy (OC). Changes in concentrations of cytokines (TNF-alpha, IL-1beta, IL-6, IL-8 and IL-10) were followed and the effect of surgical trauma on the distribution of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD19) and NK cell cytotoxicity were measured. RESULTS: After OC a decrease in circulating CD3 (p < 0.05) and CD4 (p < 0.05) and an increase in CD19 (p < 0.05) cells were detected in contrast to LC after which only CD16 cells decreased (p = 0.05). The number of CD3 cells was higher after LC than after OC (p < 0.01), whereas the number of CD19 cells was higher after OC than after LC (p < 0.01). NK cell cytotoxicity was reduced after LC (p < 0.05). In cirrhotic patients circulating cytokines were unaffected by OC, whereas TNF-alpha (p < 0.05) and IL-1beta (p < 0.05) were reduced after LC. In chronic hepatitis IL-1beta decreased after OC (p = 0.05) and IL-10 was significantly higher after LC than following OC (p < 0.05). CONCLUSION: The immune response is less pronounced after a laparoscopic procedure compared to a conventional approach in patients with chronic liver disease.     

腹腔镜胆囊切除术血清转氨酶的水平变化及原因

目的：比较腹腔镜下电刀与剪刀切除胆囊术后血清ＡＬＴ、ＡＳＴ水平变化,探讨氨酶升高的原因,方法１９９９年１１月收治的６９例胆囊结石患者随机分为两组。Ａ组３５例,电刀切除胆囊,胆囊床普遍电凝处理;Ｂ组（对照组）３４例,剪刀切除胆囊,钛夹钳闭止血,两组术中的气腹压均设定在２ｋＰａ,均于术后第１、５天测定血清ＡＬＴ、ＡＳＴ水平,结果Ａ组（电刀组）患者术后第１天ＡＬＴ、ＡＳＴ水平明显增高（Ｐ〈０．０１）,与     

Laparoscopic cholecystectomy: A report on the community hospital experience in Hokkaido

We analyzed the outcome of 1408 patients who underwent laparoscopic cholecystectomy (LC) between February 1991 and October 1993 in affiliated community hospitals around Hokkaido, Japan. LC was performed for symptomatic gallstones (68%) and asymptomatic gallstones (29%) using the pneumoperitoneum (96%) or abdominal wall lift (4%) techniques. Intraoperative and postoperative complications occurred in 105 patients (10%), including bile duct injuries in 9 patients (0.9%). Conversion to open surgery or reoperation was required in 89 patients (8%) mainly because of unclear anatomy, difficulties with hemostasis, or bile duct injury. One patient died of congestive heart failure, resulting in a mortality rate of 0.07%. The patients were discharged after an average of 8 days, and returned to work after an average of 14 days. The complication and conversion rates were high; however, the incidences of reoperation, bile duct injuries, postoperative bile leaks, and deaths were low. In conclusion, LC was performed with acceptable safety in our community hospitals. The reason for this is most likely that conventional cholecystectomy was preferred to LC in difficult cases during this early period.     

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is the preferred treatment for symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC was used to show cystic ducts that are not seen on MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with cystic ducts not seen on MRC. To our knowledge, this is the first study of visualization of a cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.     

腹腔镜胆囊切除术在老年人胆囊结石中的应用

目的 探讨老年人胆囊结石腹腔镜胆囊切除术（LC）的临床特点。方法 对1993年5月－2001年3月两院收治的310例60岁以上老年人胆囊结石行胆囊切除术的临床资料进行回顾性分析。结果 本组310例中有193（62．3％）合并有不同程度糖尿病或心血管疾病及支气管疾患。49例（15．8％）粘连严重,操作难度大,其中6例（1．93％）中转开腹,其余顺利完成LC,无胆管损伤,无严重并发症,无手术死亡。结论 尽管老年人机体老化、脏器功能衰退,免疫功能低下,合并症多,但LC损伤小、疼痛轻、并发症少,作好围手术期处理后,LC应为老年人胆囊结石胆囊切除的首选治疗方法。     

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is the preferred treatment of symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC is used to show cystic ducts that are not seen by MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with nonvisualized cystic ducts by MRC. To our knowledge, this is the first study of visualization of cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.