Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?

Background: Based on a clinical observation that the conversion rate of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) is higher in males, we decided to review our records and to verify whether a significant difference in conversion rates exists between sexes. Methods: A retrospective study on conversion rates of elective laparoscopic cholecystectomy (LC) into open cholecystectomy (LC) in relation to gender was carried out in 329 patients: 267 females and 62 males. Results: Our data revealed that the probability of conversion is fivefold greater in males than females, 21% vs 4.5%, respectively (p=0.0001). We attribute this striking difference to significantly more adhesions (p=0.0002) and anatomical difficulties (p=0.003) in males during LC, leading to conversion. Conclusions: We conclude that conversion of LC to OC is more prevalent among males and is probably attributable to a greater incidence of anatomical difficulties.     

Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

喉罩在腹腔镜胆囊切除手术中的临床应用

目的探讨喉罩在腹腔镜下胆囊切除手术对呼吸循环的影响。方法:所有病人均面罩吸氧去氮5分钟后,以Fentaly0.2mg.Norcriun 0.1mg/kg Propofol 2mg/kg静注给药诱导放置I型3号喉罩,术中观察BP、HR、EtCO2、Ppeak、SaO2。结果喉罩通气组循环稳定,BP、HR变化明显较气管插管组小。EtCO2、Ppeak、SaO2,两组无明显变化。结论使用喉罩通气进行腹腔镜下胆囊切除手术是一种安全、可靠和易行的方法。     

硬膜外麻醉与静脉复合全麻用于胆道手术的比较（附1515例分析）

目的 提高胆道手术的安全性，减少或避免胆心反射所致循环骤停的发生。方法 1515例胆道手术患者分为静脉吸入复合全麻组和硬膜外组。静脉吸入复合全麻组715例，均在芬太尼、异丙酚复合异氟醚气管内全麻下完成手术；硬膜外组800例，均于下胸段采用1％利多卡因、0．375％布比卡因间断硬膜外推液阻滞麻醉下手术。两组均行SPO2、ECG、BP、R监测。以术中胆心反射和心跳骤停发生率为观察指标，比较两种麻醉方法在胆道手术中的应用。结果 静脉复合全麻组胆心反射发生率10％，无心跳骤停发生；硬膜外组胆心反射发生率42．5％，心跳骤停0．62％。结论 胆道手术采用静脉吸入复合全麻能有效减少胆心反射和心跳骤停的发生，因此认为胆道手术(尤其老年患者)采用以静脉吸入复合全麻为主的麻醉方法可减少围麻醉期并发症。     

腹腔镜胆囊切除术手术时间对机体免疫功能的影响

目的　研究腹腔镜胆囊切除术时间长短对机体免疫功能的影响。方法　将 4 0例胆囊切除术病人按手术时间长短分为两组 ,A组 (<1h) ,B组 (≥ 1h) ,每组 2 0例。围手术期测T淋巴细胞亚群 (包括CD3 、CD4、CD8及CD4/CD8比值 )、免疫球蛋白 (IgA、IgM、IgG)和补体 (C3 、C4)浓度。结果　外周血CD3 、CD4含量 ,血清IgG浓度 ,两组手术后明显降低 (P <0 0 5 ) ,两组间相比差异有显著意义 (P <0 0 5 )。外周血CD4/CD8比值 ,血清IgM、IgA ,C3 及C4浓度只有在B组手术后明显降低 (P <0 0 5 ) ,其中外周血CD4/CD8比值、C3 浓度在两组间比较差异有显著意义 (P <0 0 5 )外 ,其余无差异。结论　腹腔镜胆囊切除术手术时间的延长进一步抑制机体免疫功能。     

腹腔镜腹部手术520例临床分析

目的探讨腹腔镜在腹部手术中的应用及并发症的预防。方法回顾性分析2001年3月～2005年3月腹腔镜下胆囊切除、阑尾切除、溃疡病穿孔修补、肠粘连松解、肝囊肿开窗、直肠癌前切术等520例临床资料。结果腹腔镜手术应用12种类，520例中有5例因胆囊三角解剖不清且胆囊萎缩而中转开腹手术，2例因术中出血而中转开腹。手术并发症3例（0．58％），其中胆管损伤2例。出血1例。结论腹腔镜手术的适应证随技术进步和设备改善将逐步拓宽；严格腹腔镜手术程序，严重并发症发生率可降低。     

Cholecystectomy: costs and health-related quality of life: a comparison of two techniques.

BACKGROUND: Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent. OBJECTIVE: To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations. DESIGN: Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999. SETTING: One university hospital and four non-university hospitals in Sweden. MAIN MEASURE: : Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D. RESULTS: Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found. CONCLUSION: Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.     

腹腔镜胆囊切除术围手术期的护理及其进展

腹腔镜胆囊切除术具有损伤小,疼痛少,病人恢复快,住院时间短等显著优势,已成为良性胆囊疾病胆囊切除的金标准,而术前进行健康指导、心理护理,术中密切配合手术和监测生命体征,术后腔镜手术的特殊护理和严密观测并发症有无,及时指导配合处理则能进一步消除病人忧虑,促进康复.全面细致的健康教育与心理护理在腔镜手术围手术期显得更加重要.     

Comparative study of open tension-free and laparoscopic inguinal hernia repair in hernioplasty and simultaneous laparoscopic cholecystectomy

Objective: To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods: Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperiloneal mesh hernia repair (TEP) and laparoscopic cholecystectomy (LC), 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC, and 15 cases underwent LC and open tension free hernia repair. Results: All the procedures were performed successfully, 2 patients occurred urinary retention in LC + open group and 1 patient occurred scrotum seroma in LC + TEP procedures. During the 6 to 24 months' follow-up, no hernia recurrences occurred in all patients. There were 6 patients (40%) in LC + open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group (TEP + LC and TAPP + LC) (104±31 min) than in the LC+open group (80±28 min) (P<0. 05). The intensity of postoperative pain at rest was greater in the LC + open group at 24 h (P<0. 05) and 48 h (P<0. 05). No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking (2. 9 vs 1. 8 d) (P<0. 01) and the mean hospital stay (8. 2 vs 4. 6 d) (P<0. 001) was longer in the LC + open group than in the totally laparoscopic group. Conclusion: In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.     

A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: Value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy

A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.