腹腔镜胆囊切除术治疗急性胆囊炎152例临床分析

目的总结急性胆囊炎行腹腔镜胆囊切除术（LC）的经验体会。方法2003年1月至2006年12月152例急性胆囊炎患者行腹腔镜胆囊切除术。CO2气体建立气腹,常规四孔法。结果140例患者成功完成腹腔镜胆囊切除术,12例患者因胆囊粘连致密易出血中转开腹;152例患者温氏孔放置引流管;148例随访5～48个月,平均30个月,无并发症发生,无死亡病例。结论严格掌握急性胆囊炎腹腔镜手术治疗的指征,规范腹腔镜操作技术,适时中转开腹,引流管的放置,是保证手术成功的关键。     

胆石症患者与正常人胆汁33500泡蛋白成核活性的比较

目的比较胆石症患者与正常人的胆汁33 500泡蛋白成核活性。方法利用超速离心法从正常人及胆石症患者胆汁中纯化33 500泡蛋白,采用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳鉴定其纯化效果。通过Holan法测定成核时间,计算成核活性。结果胆石症患者的33 500泡蛋白平均成核时间为(3.8±0.7)d,成核活性中位数达0.303,具有强促成核作用,能显著缩短成核时间,促进胆固醇结晶形成。而正常人促成核作用较弱,平均成核时间为(8.4±0.9)d,成核活性中位数仅为0.667。胆石症患者与正常人胆汁33 500泡蛋白平均成核时间及促成核活性的差异均有统计学意义(P值均<0.05)。结论与正常人相比,胆石症患者的胆汁33 500泡蛋白促成核活性明显增强。     

Commentary on “Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report’’

The present letter to the editor is related to the study titled “Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report’’. Although gallstones are relatively common diseases, its association with thromboembolism is not fully understood. We aim to emphasize the potential mechanism of this relationship in this letter. In addition, we wanted to contribute to the causes of the spleen infarction and celiac trunk pathologies.     

Long-term incidence of gallstone disease after bariatric surgery: results from the nonrandomized controlled Swedish Obese Subjects study

BackgroundGallstone disease is a known short-term complication of bariatric surgery; little is known of the long-term incidence.ObjectivesThe aim of this study was to investigate the association between bariatric surgery and long-term incidence of gallstone disease.SettingsA total of 25 surgery departments and 480 primary healthcare centers in Sweden.MethodsThe Swedish Obese Subjects study is a prospective, controlled study comparing the effects of bariatric surgery with usual care with a follow-up of 20 years, including 4047 individuals. The current report includes all participants without previous or concomitant cholecystectomy (n = 3597). Operative techniques used in the surgery group (n = 1755) were gastric bypass (n = 236), vertical banded gastroplasty (n = 1202), and gastric banding (n = 317). The control group (n = 1842) received customary treatment for obesity. Gallstone disease was a predefined secondary endpoint in the Swedish Obese Subjects study and the primary endpoint of this report. Data were obtained by cross-checking our study database with the Swedish National Patient Register of diagnosis and procedures.ResultsIn the surgery and control groups, respectively, there were 307 and 252 first-time events of symptomatic gallstone disease and 230 and 170 cholecystectomies (log-rank P < .001, both outcomes). Bariatric surgery was associated with an increased risk of symptomatic gallstone disease, with a more pronounced risk during the first years of follow-up (P = .002) and an increased risk for cholecystectomy but with no time-varying effect (P = .213).ConclusionsBariatric surgery increases the risk for symptomatic gallstone disease and cholecystectomy, especially during the first years following treatment.     

Outcomes of delayed endoscopic retrograde cholangiopancreatography in patients with acute biliary pancreatitis with cholangitis

ObjectiveThe recommended treatment for acute biliary pancreatitis(ABP) with cholangitis is urgent endoscopic retrograde cholangiopancreatography(ERCP). However, tight schedules in the endoscopy room mean that urgent ERCP may not always be performed. This study aimed to compare the outcomes of early (≤72 h) and delayed(>72 h) ERCP in patients with ABP with cholangitis.MethodsNinety-five patients diagnosed with ABP with cholangitis who underwent ERCP between May 2012 and April 2018 were retrospectively reviewed.ResultsSixty-seven patients(70.5%) were classified in the early ERCP and 28(29.5%) in the delayed ERCP groups. There was no significant difference in pancreatitis severity between the groups. Total bilirubin was higher in the early compared with the late ERCP group (5.7 ± 5.2 versus 3.5 ± 2.3 mg/dL, p = 0.03). Fewer patients in the early group had end-stage renal disease (0 versus 3, p = 0.006) and relatively fewer patients in the early group took aspirin (15(22.4%) versus 12(42.9%), p = 0.04). There were no significant differences between the early and delayed ERCP groups in terms of mortality (2(3.0%) versus 0), disease-related complications(11 (16.4%) versus 5(17.9%), p = 0.86), or ERCP-related complications(5(7.5%) versus 3(10.7%), p = 0.60). The total length of stay(LoS) was shorter in the early group(6.3 ± 4.4 versus 9.8 ± 6.1 days, p = 0.002). The rate of complete stone removal was lower in the early compared with the delayed ERCP group(32/42(76.2%) versus 18/18(100%), p = 0.02).ConclusionDelayed ERCP can be performed in selected patients with ABP with cholangitis, with similar complication rates but longer LoS compared with early ERCP.     

胆石性肠梗阻的诊治进展

胆石性肠梗阻是胆石症的罕见并发症之一,多见于老年患者.该病临床表现缺乏典型性,术前确诊有很大难度,腹部CT平扫是首选的诊断方式.手术治疗是目前最主要的治疗手段,要根据患者的自身情况,选择个体化的手术方式.内镜、腹腔镜等微创取石术是很有前景的治疗手段,随着相关技术的发展将会越来越多的运用于胆石性肠梗阻的治疗.     

胆囊结石合并胆总管结石患者腹腔镜切除与胆管取石同期手术与分期手术效果比较

目的比较胆囊结石合并胆总管结石患者腹腔镜切除与胆管取石同期手术与分期手术的效果。方法选择我院2013年1月~2016年3月期间收治的92例胆囊结石合并胆总管结石患者作为研究对象,按随机数字表分为A组与B组。A组采取腹腔镜联合十二指肠镜一阶段法同期治疗(IO-ERCP/EST+LC),B组采取腹腔镜联合十二指肠镜两阶段法治疗(PreERCP/EST+LC)。比较两组手术完成率、结石清除率、手术时间、术中出血量、术后并发症发生率、下床活动时间、排气时间、住院时间及住院费用。结果 A组与B组手术完成率分别为91.7%、95.5%,结石清除率分别为86.4%、84.1%,差异无统计学意义(P0.05)。两组手术时间、术中出血量、术后下床活动时间及排气时间的差异无统计学意义(P0.05)。A组、B组术后并发症总发生率分别为11.4%、9.5%,差异无统计学意义(P0.05)。A组住院时间与住院花费分别为(4.2±1.3)d、(2.4±0.6)万元,低于B组(5.9±1.5)d、(1.7±0.4)万元,差异统计学意义(P0.05)。结论腹腔镜联合十二指肠镜同期治疗胆囊结石并胆总管结石与分期手术相比可减小手术创伤,缩短住院时间从而减少医疗花费,为安全、可行、经济的微创手术方式。     

Comparison of early and delayed cholecystectomy for biliary pancreatitis: A meta-analysis

BackgroundBiliary stones are the most common etiology of acute pancreatitis Cholecystectomy has been accepted as a popular treatment for acute biliary pancreatitis (ABP) to reduce the risk of recurrent complications. However, the precise time of intervention still remains controversial.ObjectiveThe aim of this meta-analysis was to compare early and delayed cholecystectomy and determine the most precise timing of cholecystectomy following gallstone pancreatitis.MethodSearch the publications on comparison the efficacy of early cholecystectomy comparison with delayed cholecystectomy in treatment outcomes of ABP to October, 2018. After rigorous reviewing on quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest, including survival data and individual postoperative complications.ResultsA total of 9 trials were met our inclusion criteria. The pooled results indicate that postoperative complications、readmission rate、conversion to an open procedure and cholecystectomy-related morbidity/mortality did not have statistical significance (P > 0.05) between the early and delayed cholecystectomy. While, the length of hospital stay was shorter for the early cholecystectomy group than the delayed group in all included studies.ConclusionsAlthough the efficacy of delayed intervention in terms of inflammation reduction is definite, their adverse events are often major limitations. In the present study, an early cholecystectomy may result in a significantly shortened hospital stays without increased complications or mortality.     

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。     

老年胆囊结石患者腹腔镜胆囊切除术的体会

目的:探讨老年胆囊结石患者腹腔镜胆囊切除术(LC)的特点。方法:回顾性分析近两年行LC的72例老年胆囊结石患者的临床资料。结果:72例老年胆囊结石患者中46例(约64％)合并有不同程度糖尿病、或心和血管疾病及支气管疾患。手术时见72例中7例(9.7％)胆囊与周围组织广泛粘连,手术操作难度较大。但无1例出现LC并发症,无1例死亡,无1例中转开腹。72例均顺利出院。结论:老年人可耐受LC,且安全可靠,充分的围手术期处理、仔细的手术操作是成功的关键。