日间腹腔镜胆囊切除术的可行性分析

目的:探讨日间腹腔镜胆囊切除术(DCLC)的可行性.方法:回顾分析2018年1月1日至2019年12月31日施行腹腔镜胆囊切除术患者的临床资料,分为DCLC组与常规腹腔镜胆囊切除术(RLC)组.对比两组患者一般情况、手术安全性、卫生经济学指标.结果:共纳入1870例患者,其中DCLC组246例,RLC组1624例.计划...     

日间腹腔镜胆囊切除术25例分析

目的 探讨日间腹腔镜胆囊切除术的可行性.方法 对由同一名医师连续手术的日间腹腔镜胆囊切除术25例进行分析.结果 25例LC全部成功,手术时间平均为15 min;手术次日全部出院,无延迟出院和再入院患者;术后并发症仅皮下气肿1例;术后腹胀2例,发热3例,轻度疼痛6例,恶心3例,均于72 h内缓解.结论 日间腹腔镜胆囊切除术安全可行.     

日间腹腔镜胆囊切除术的临床应用分析

目的 探讨日间腹腔镜胆囊切除术(ambulatory laparoscopic cholecystectomy,ALC)的可行性.方法 回顾性分析2008年7月至2010年4月由同一位医生连续进行LC的患者临床资料,其中常规腹腔镜胆囊切除术(routine laparoscopic cholecystectomy,RLC)组75例,ALC组36例.结果 两组在手术成功率、负压引流留置率、再入院率、并发症发生率、术后发热发生率、切口疼痛发生率、恶心呕吐发生率比较均无统计学差异(P>0.05);日间组手术时间(25.3±11.1)min,显著短于常规组的(32.4±12.7)min(P<0.05);日间组住院费用(7729.6±475.7)元,显著低于常规组的(9337.9±692.8)元(P<0.05);日间组住院时间(1 d,1~3)显著短于常规组(5 d,3~10)(P<0.05).结论 ALC安全可行,显著减少住院时间及住院费用.     

基层医院开展日间腹腔镜胆囊切除术的可行性探讨

目的：探讨基层医院开展日间腹腔镜胆囊切除术（day surgery laparoscopic cholecystectomy,LC/DS）的可行性。方法：回顾分析65例常规LC患者与22例LC/DS患者的病例资料,对两组患者的术前等待时间、住院时间、住院费用进行统计学分析。结果：两组患者均顺利康复出院,无并发症发生;LC/DS组术前等待时间（1天内100%）显著短于常规LC组（1天内7.69%、大于1天92.31%）（P〈0.01）;LC/DS组住院时间（1天内100%）显著短于常规LC组（1天内0、大于1天100.00%）（P〈0.01）;住院费用（7 500元内95.45%）显著低于常规LC组（7 500元内12.31%、大于7 500元87.69%）（P〈0.01）。结论：日间手术的开展可缓解＂看病难、住院难、术前等待时间长、住院费用高＂等问题;因受诸多因素的影响,基层医院开展LC/DS原则上是可行的,但考虑患者的安全需慎重选择。     

日间模式应用于腹腔镜胆囊切除术的疗效分析

目的 评价和分析日间模式应用于腹腔镜胆囊切除术(LC)的临床疗效.方法 收集2017年6月至2019年2月期间于新疆医科大学第一附属医院行LC患者,根据入院流程模式分为日间LC组(ALC)和常规LC组(CLC组),ALC组在日间手术病房接受LC,CLC组在普通病房接受LC.比较2组患者术前等待时间、术后胃肠道功能恢复时...     

急诊日间腹腔镜胆囊切除术可行性及影响因素分析

目的 探讨日间手术管理模式下完成急诊腹腔镜胆囊切除术（LC）的可行性并分析影响因素。方法回顾性分析2021年1—12月北京协和医院基本外科收治的急诊行LC的271例病人的临床资料。按术后住院时间分为日间管理组（住院时间≤48 h,133例）和常规组（住院时间>48 h,138例）。比较两组病人的基线资料、手术情况和术后恢复情况。结果 日间管理组与常规组病人在年龄、ASA分级、上腹部手术史、术前白细胞（WBC）计数、术前中性粒细胞百分比（NEUT%）、术前白蛋白方面比较差异有统计学意义（P<0.05）。日间管理组较常规组的手术时间缩短,且无术后并发症发生,术后放置引流和使用抗生素的比例相对较低（P<0.05）。多因素Logistic回归分析显示,高龄、上腹部手术史、ASA分级≥Ⅲ级、WBC计数和总胆红素升高是急诊LC后住院时间延长的独立危险因素。结论 在急诊医疗资源相对缺乏的情况下,经过筛选后的部分LC可以在日间手术管理模式下完成;对于高龄、有上腹部手术史、ASA分级≥Ⅲ级、WBC计数和总胆红素升高的病人,应谨慎行急诊日间LC。     

腹腔镜胆囊切除术复杂情况的处理

目的探讨腹腔镜胆囊切除术（LC）中复杂情况的处理方法及手术安全性。方法对107例复杂情况的腹腔镜胆囊切除术患者的临床资料进行回顾性总结。结果全组107例，103例成功行LC，4例中转开腹，全部治愈出院，无并发症发生。结论对于复杂情况的胆囊结石患者，只要方法得当，LC仍是一种安全有效的手术方法。     

舒芬太尼在日间腹腔镜胆囊切除术的临床应用

目的:探讨舒芬太尼-七氟烷静吸复合麻醉在日间腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:将择期行日间LC的患者随机分为观察组与对照组,每组20例,观察组使用舒芬太尼(0.4μg/kg)进行麻醉,对照组使用芬太尼(4μg/kg)麻醉。观察两组患者麻醉期(术前到拔管)及术后生命体征(BP、HR、SPO2)、手术时间、苏醒时间、拔管时间、PACU躁动发生率及躁动程度、术后疼痛分级、术后镇痛药及麻醉并发症等指标。结果:两组患者麻醉诱导后血压、心率均较术前下降(P<0.05),组间相比差异无统计学意义(P>0.05);观察组苏醒时间及拔管时间、意识恢复时间、术后疼痛指数均优于对照组,差异有统计学意义(P<0.05);观察组PACU躁动发生率为5%,对照组为20%。结论:舒芬太尼较芬太尼在镇痛效果、镇痛时间、术后意识恢复、降低术后躁动发生率等方面具有一定优势,应用于日间LC的麻醉安全、有效。     

腹腔镜胆囊切除日间手术30例临床分析

目的:探讨日间手术模式在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的安全性及可行性。方法:2014年4月28日至2014年7月20日拟行日间LC 30例,其中胆囊结石16例,胆囊息肉11例,胆囊结石合并胆囊息肉2例,慢性胆囊炎1例。患者术前于门诊行术前检查并进行准入评估。术后当日密切观察患者各项生命体征并进行出院评估。术后5 d内每天均对患者进行电话随访,了解并记录患者身体状况。结果:30例拟行日间手术的患者中,3例经术前检查未达日间手术准入标准转入常规住院治疗,余27例均顺利完成日间LC,其中26例于24 h内出院,术后无并发症或仅有轻微不适,1例术后体温达38.5℃,未达日间手术出院标准留院观察3 d后出院。结论:日间LC安全、可行,可降低医疗费用,适合在我国大型医院开展。     

日间手术不影响腹腔镜胆囊切除术患者的生活质量:中国经验

目的:评估在中国这样一个人口众多、医疗资源相对不足的国家推广日间腹腔镜胆囊切除术(day-care laparo-scopic cholecystectomy,DCLC)的可行性,总结其短期临床疗效及对生活质量的影响。方法:2009年9月1日至2010年3月31日共纳入167例患者,依据所在医院分别行DCLC(DCLC组)及常规腹腔镜胆囊切除术(conventional laparoscopic cholecystecto-my,CLC)(CLC组)。记录手术相关情况及术后并发症。采用SF-36和消化系统疾病生活质量(gastrointestinal quality of life in-dex,GIQLI)量表分别于术前、术后2周及术后1个月记录患者生活质量。结果:两组患者年龄、性别、体重指数、ASA评分、手术指征、手术时间、出血量及术后并发症等差异无统计学意义(P>0.05)。研究期间无二次入院患者。术前、术后2周及术后1个月两组患者SF-36及GIQLI各维度差异亦无统计学意义(P>0.05)。住院时间及扣除耗材费用后的住院费用DCLC组显著优于CLC组(P<0.05)。结论:DCLC安全有效,可缩短住院时间、降低住院费用,在生活质量方面与CLC相比差异无统计学意义,日间手术在中国推行是可行的。     

Laparoscopic Splenectomy Coupled with Laparoscopic Cholecystectomy

Background and Objectives:

The aim of this study was to evaluate the results of laparoscopic surgery performed for coexisting spleen and gallbladder surgical diseases.

Methods:

Between May 2004 and October 2012, 12 patients underwent concomitant laparoscopic splenectomy and cholecystectomy. Indications for surgery included idiopathic thrombocytopenic purpura in 5 patients, hereditary spherocytosis in 4 patients, and thalassemia intermedia in 3 patients.

Results:

The mean operative time was 100 minutes (range, 80–160 minutes), and the blood loss ranged from 0 to 150 mL (mean, 50 mL). The mean longitudinal diameter of the spleen was 14 cm. One patient required conversion to open procedure. An accessory spleen was detected and removed in one case. The mean length of hospital stay was 5 days. No deaths or other major intraoperative and/or postoperative complications occurred.

Conclusion:

Provided that the technique is performed by an experienced surgical team, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases.     

肝硬化患者的腹腔镜胆囊切除术72例分析

目的探讨肝硬化患者施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性。方法回顾性分析2002年7月~2007年3月72例Child-PughA、B级肝硬化行LC的临床资料。全麻,四孔法,气腹压力8~12mmHg。结果71例完成LC(顺行切除67例,逆行切除4例),其中6例行胆囊大部分切除;因胆囊三角区致密粘连中转开腹1例。手术时间35~105min,平均51min;出血量5~60ml,平均12ml;术后住院时间3~11d,平均5.6d。术后出现腹水7例,穿刺孔出血1例。71例随访3~18个月,平均12个月,临床症状消失,无结石复发及残留。结论在充分做好术前准备,恰当的术中及术后处理的情况下,肝硬化病人行LC是安全的,对于肝功能A、B级须切除胆囊者应首选LC。     

Laparoscopic Cholecystectomy with Previous Gastrectomy

ABSTRACT

Introduction: To evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) in patients with a history of gastrectomy. Methods: The clinical data of 9,403 consecutive patients who underwent LC from January 2003 to September 2010 in our hospital were retrospectively analyzed; 30 of them had undergone previous gastrectomy. We compared the operative duration, hospitalization, and conversion rate between patients with, and those randomized selected patients without, a history of gastrectomy. Results: All patients were treated by laparoscopic procedure successfully. The mean operative duration (55.00 min vs. 29.63 min, P < .05) and mean hospitalization duration (4.57 days vs. 3.00 days, P < .05) were significantly longer in the patients with a history of gastrecotomy. There are no complications such as bile duct and bowel injury in control group, however two bile duct injuries emerged in the observed group, which required surgical intervention. Conclusions: Although the operation is difficult, LC is a safe and effective treatment for the patients with a history of gastrectomy.     

经脐单切口微型腔镜胆囊切除术与传统腹腔镜胆囊切除术的比较

目的比较微型腔镜下经脐单切口胆囊切除术与传统腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床效果,探讨应用常规器械行经脐单切口微型腔镜胆囊切除的可行性。方法 2010年6～11月60例胆囊良性疾病按手术日分为2组,由同一手术组医师分别施行经脐单切口微型腔镜胆囊切除术与传统LC,前者除换用3 mm尿道镜外,余均使用同样的设备和操作器械,比较2组手术时间、术中出血量、术后疼痛评分、术后并发症、总住院费用及术后住院时间。结果 2组均完成胆囊切除,无中转开腹手术,术后无并发症发生。传统组手术时间（47.7±21.6）min明显短于单切口组（62.6±30.6）min（t=2.179,P=0.033）,2组术中出血量、术后疼痛评分、总住院费用及术后住院时间无显著性差异（P〉0.05）。结论 微型腔镜下单切口胆囊切除术可行,不仅具有传统LC的优点,还具有切口隐蔽性好,更好的美容效果等特点。     

Laparoscopic Transumbilical Cholecystectomy: Surgical Technique

Background:

Laparoscopic cholecystectomy is generally performed using 4 ports by transperitoneal access. Recent developments regarding laparoscopic surgery have been directed toward reducing the size or number of ports to achieve the goal of minimally invasive surgery, by minilaparoscopy, natural orifice access, and the transumbilical approach. The aim of this article is to describe our laparoscopic transumbilical cholecystectomy technique using conventional laparoscopic instruments and ports.

Methods:

The Veress needle was placed through the umbilicus, which allowed carbon dioxide inflow. A 5-mm trocar was placed in the periumbilical site for the laparoscope followed by the placement of 2 additional 5-mm periumbilical trocars. The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed, and all 3 periumbilical skin incisions were united for specimen retrieval.

Results:

Five transumbilical cholecystectomies were performed following this technique. The mean BMI was 26.6 kg/m². The mean operative time and blood loss were 46.2 minutes and 55 mL, respectively. No intraoperative complications occurred. Analgesia was performed using dipyrone (1g IV q6h) and ketoprofen (100 mg IV q12 h). Time to first oral intake was 8 hours. Mean hospital stay was 19.2 hours.

Conclusion:

Laparoscopic transumbilical cholecystectomy seems to be feasible even using conventional laparoscopic instruments and can be considered a potential alternative for traditional laparoscopic cholecystectomy.     

Laparoscopic Cholecystectomy in Cirrhotics

Background and Objectives:

Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure.

Methods:

A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified.

Results:

Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed.

Conclusions:

Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate.     

Cholecystocholangiography During Laparoscopic Cholecystectomy

The aim of this study was to assess the efficacy and safety of performing cholecystocholangiography through a central venous pressure catheter during laparoscopic cholecystectomy. Laparoscopic cholecystocholangiography was attempted during laparoscopic cholecystectomy for chronic calculous cholecystitis in 40 patients, and considered successful if the biliary anatomy was clearly defined. The procedure was evaluated as successful in 36 patients (90%). It added an average 13.5 min to the operating time. A unsuspected common bile duct stone was identified by cholecystocholangiography in one patient and there were no cholangiogram-related complications. We concluded that laparoscopic cholecystocholangiography is a safe, simple, and quick procedure that can be used as an alternative to cystic duct cholangiography to identify the biliary anatomy and detect any common bile duct calculi prior to laparoscopic dissection. Received: May 1, 2000 / Accepted: March 6, 2001     

腹腔镜胆囊次全切除术168例报告

目的探讨腹腔镜胆囊次全切除术(laparoscopic subtotal cholecystectomy,LSC)的可行性和技术特点。方法对168例因各种原因无法完成腹腔镜胆囊切除术的患者转行LSC,方法包括从分离Calot三角开始和从切开Hartmann袋减压、取石开始。结果5例中转开腹行胆囊次全切除术;122例在胆囊管和胆囊动脉夹闭后行胆囊大部切除;41例先在Hartmann袋处切开胆囊,然后寻找、夹闭胆囊管和胆囊动脉或缝扎胆囊颈部,再行胆囊大部切除。手术时间(65.5±15.2)min,术中出血量(71.5±15.5)ml,术后恢复进食时间(20.4±6.3)h,出现局部并发症7例(4.2%),术后住院时间(4.2±2.6)d。105例随访(25.5±6.5)月,消化不良5例,右肩牵涉痛3例,右上腹部不适9例。结论对于复杂胆囊炎,LSC是可行的,术者要熟练掌握LSC的技术特点,正确处理好出血和胆漏是LSC成功的关键。     

改良的二孔法腹腔镜胆囊切除术

目的探讨改良的二孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的疗效。方法 2009年7月～2011年3月对152例胆囊良性病变脐部5 mm戳孔改用软质无通气阀的trocar,配以长柄向外侧弯曲抓钳施行二孔法LC,均未放置腹腔引流管。结果 151例成功施行二孔法LC,1例因胆囊三角显露困难行三孔法LC。手术时间35～70 min,平均45 min;术中出血量10～50 ml,平均15 ml。术后切口疼痛轻微,无出血、胆漏、感染等并发症,2例术后出现右下腹持续性疼痛,B超检查示肠道积气,经对症处理后缓解。脐部切口隐藏于脐内缘,仅剑突下一5 mm瘢痕。152例术后随访12个月,恢复良好,美容效果满意。结论改良的二孔法LC安全可行,疗效满意。     

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.