腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石患者的近远期效果分析

目的分析腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石患者的近远期效果。方法选取2017年1月至2018年1月我院收治的78例胆囊结石合并胆总管结石患者为研究对象,采用随机数字法将其分为传统组和腹腔镜组,各39例。传统组给予开腹胆囊切除术联合胆总管切开取石术治疗,腹腔镜组给予腹腔镜胆囊切除术治疗。比较两组手术前、后的疼痛缓解情况、应激反应指标、临床治疗效果、并发症发生情况及术后1年的复发率。结果手术后1个月,两组的NRS评分明显降低,且腹腔镜组明显低于传统组(P<0.05)。手术后,腹腔镜组的CRP及IL-6水平均低于传统组(P<0.05)。腹腔镜组的临床治疗总有效率为94.87%,明显高于传统组的71.79%(P<0.05)。腹腔镜组的并发症总发生率为7.69%,明显低于传统组的33.33%(P<0.05)。腹腔镜组术后1年的复发率明显低于传统组(P<0.05)。结论腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石患者的近远期效果更加显著,值得临床推广应用。     

Measuring the rate of weight gain and the influential role of diet in patients undergoing elective laparoscopic cholecystectomy: a 6-month follow-up study

Weight gain after cholecystectomy is one of the major surgical problems consistent with morbidities and long-term mortalities. Here, we aimed to study the impact of palliative cholecystectomy on weight gain and nutritional status of the patients before and in 1, 4 and 6 months after surgery. We performed a prospective survey on a cohort of 48 patients undergoing elective cholecystectomy. The nutritional status of the patients was collected by nutrition nurse and analysed by NutriBase software. There were 13 (16%) females and 35 (84%) males with the mean age of 51.8 ± 1.97. In 6 months after surgery, patients had higher values of BMI, daily energy expenditure, carbohydrate and lipid consumption and a decreased level of protein consumption. Weight gain after surgery was caused by an increase in fat consumption which resulted in the weight gain and worsening of lipid profile. Dietary consultation, shortly after surgery, would improve patient outcome after cholecystectomy.     

LC术后胆管损伤合并肝动脉损伤的临床表现与治疗

腹腔镜胆囊切除术合并肝动脉损伤、胆管损伤较为常见,其临床表现不一,且从长远角度考虑疗效仍然欠佳。腹腔镜胆囊切除术术后胆管损伤合并肝动脉损伤较单一肝动脉损伤临床表现更为复杂,治疗方法更为棘手,故其治疗方案等依然是临床研究的重点。现就腹腔镜术后造成胆管损伤、肝动脉损伤的临床表现、诊断方法、治疗手段及结果进行综述,以期为临床提供相应依据。     

腹腔镜胆囊切除术患者肝功能指标的意义

目的对比不同种类的腹腔镜胆囊切除术(LC)患者手术前后的肝功能状况,探讨胆囊结石患者的肝功能检查的价值。方法对本院收治的386例腹腔镜胆囊切除术患者和16例行传统开腹胆囊切除术患者的临床资料进行回顾性分析,对不同患者术前和术后第3天及术后一月的肝功能情况进行比较。结果 不同患者的术前及术后肝功能指标上升有明显区别。结论 腹腔镜胆囊切除术患者的肝功能指标对诊断与治疗均有重要意义。     

胆囊息肉诊治的新进展

【摘要】 随着B超等影像学技术的广泛普及,胆囊息肉样病变(PLG)检出率越来越高,已成为胆道外科的常见疾病。目前针对PLG的处理方式主要是手术治疗,而迄今又无有效的方法在手术前明确PLG的类型,因此使得临床上大部分无恶变倾向的PLG实施了不必要的预防性胆囊切除术。鉴于此,本文将对PLG与恶变关系等进行综述,系统地认识PLG及其恶变的危险因素,从而确定预防性胆囊切除的手术指征及临床意义。     

LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ABDOMINAL PROPHYLACTIC DRAINAGE

Aim: As techniques in laparoscopic cholecystectomy (LC) have improved, the role of routine prophylactic abdominal drainage may be limited. A retrospective review was carried out of patients undergoing elective LC to evaluate the benefit of routine drainage in simple uncomplicated procedures. Methods: This study of 295 patients with cholecystolithiasis or gallbladder polyp included 145 patients who underwent LC with drainage and 150 patients who underwent LC without drainage between 2003 and 2007. Allocation to drain or not to drain was non‐randomized and based on surgeon preference according to intraoperative findings. Patient characteristics, operative results, and postoperative outcomes were compared between the two groups with univariate analysis. Results: Time to first flatus and length of postoperative hospital stay in the LC without drainage group were shorter than in the LC with drainage group. There was no significant difference between the two groups with respect to postoperative complication rate. No complications were noted due to the lack of drain placement. Conclusion: The use of drain after simple elective uncomplicated LC could safely be limited to appropriate patients as judged by the operating surgeon.     

Late Port Site Metastasis from Occult Gall Bladder Carcinoma After Laparoscopic Cholecystectomy for Cholelithiasis: The Role of 18F-FDG PET/CT

Late port site metastasis of gall bladder carcinoma (GBC) after laparoscopic cholecystectomy is a rare finding. Rarer still is such a presentation where the GBC remained occult at histopathology. ¹⁸F-flurodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) can play an important role in this setting by supporting the diagnosis of port site metastasis, by demonstrating additional sites of metastasis, if any, and by ruling out any other primary site. We here present two such patients with late port site metastasis of occult GBC after laparoscopic cholecystectomy for cholelithiasis and discuss the role of ¹⁸F-FDG PET/CT in this setting.