Laparoscopic Cholecystectomy in Obese and Nonobese Patients

Background: From November 1997 to November 1998, 145 cases of laparoscopic cholecystectomy (LC) have been attempted at the District General Hospital of Corfu. Methods: 23 (15.8%) were obese (Group I, BMI >30) and 122 (84.2%) were nonobese patients (Group II, BMI ≤30). One-fifth of these patients suffered from acute cholecystitis. Results: Operative time averaged 95 minutes in Group 1 and 78 minutes in Group II. There were no deaths. There were no significant differences between the obese and nonobese groups in conversion to open procedure (Group1: 0%, Group II: 2.4%), intraoperative and postoperative complications (Group I: 4.3%, Group II: 4.0%), operating time, and length of postoperative hospitalization. Conclusion: LC was a safe and effective treatment for obese patients with symptomatic cholelithiasis.     

腹腔镜手术治疗急性胆囊炎126例分析

目的总结腹腔镜下行急性胆囊炎切除术的临床经验。方法回顾分析126例急性胆囊炎患者行LC的临床资料。结果121例成功完成LC，成功率93．03％，5例中转开腹，中转率3．97％，5例均在发病超过72h行LC；其中Calot三角区严重水肿、粘连致密，无法辨清胆管关系3例，胆囊癌1例，胆囊十二指肠瘘1例。126例均痊愈出院，无手术并发症发生。结论合理地选择病人，把握住手术时机并注重手术技巧，急性胆囊炎患者行LC是安全可行的。     

老年人胆囊炎围手术期处理

目的 探讨老年人胆囊炎围手术期处理方法。方法 回顾性分析80例60岁以上胆囊炎患者的外科手术资料。结果 80例中治愈78例，治愈率97．5％；死亡2例，占2．5％；发生术后并发症5例，占6．25％。结论 老年人对胆囊手术一般都能耐受，早期手术治疗，选择合适的手术方式及正确的术后护理是提高治愈率、降低死亡率的关键。     

医源性胆管损伤21例治疗体会

目的总结医源性胆管损伤的原因、预防及处理经验。方法对21例医源性胆管损伤的临床资料进行回顾性分析。结果本组21例病例中,痊愈出院17例（81%）,死亡1例（4.8%）,死亡原因为胆汁性腹膜炎导致的感染中毒性休克。3例术后晚期胆管狭窄患者,经单纯的ERCP扩张并置支架内引流,效果不佳,自动放弃手术治疗。术后存活的17例患者中,术后1年有3例出现胆管炎反复发作,影像学证实为胆管再狭窄,经再次手术后痊愈。结论提高对医源性胆管损伤的认识和术中细致的解剖是预防的关键。胆管空肠吻合术是医源性胆管损伤或损伤性胆管狭窄的修复重建的主要手段。     

大柴胡汤加减治疗内科杂证

大柴胡汤加减治疗胆囊炎、胆石症、急性胰腺炎、便秘、肺炎、偏头痛等内科杂证。     

Non-obstetrical acute abdomen during pregnancy

Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. The incidence of acute abdomen during pregnancy is 1 in 500-635 pregnancies. Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is still inaccurate. Laboratory parameters are not specific and often altered as a physiologic consequence of pregnancy. Use of laparoscopic procedures as diagnostic tools makes diagnosis of such conditions earlier, more accurate, and safer. Appendicitis is the most common cause of the acute abdomen during pregnancy, occurring with a usual frequency of 1 in 500-2000 pregnancies, which amounts to 25% of operative indications for non-obstetric surgery during pregnancy. Surgical treatment is indicated in most cases, as in nonpregnant women. Laparoscopic procedures in the treatment of acute abdomen in pregnancy proved safe and accurate, and in selected groups of patients are becoming the procedures of choice with a perspective for the widening of such indications with more frequent use and subsequent optimal results. Despite these advances, laparotomy still remains the procedure of choice in complicated and uncertain cases.     

Current trends in imaging evaluation of acute cholecystitis

This study was designed to retrospectively determine recent clinical trends of initial radiological evaluation in patients pathologically proven to have acute cholecystitis (AC) and to assess the methodology that led to its diagnosis. Over a 28-month period, the medical records and imaging studies of 117 consecutive patients who had pathologically confirmed AC were retrospectively analyzed. The sensitivities of ultrasound (US) and hepatobiliary ^99mTc-iminodiacetic acid (HIDA) were computed. The false-negative scans were retrospectively reviewed by a blinded radiologist to determine the limitations and advantages of each modality. The 117 patients were grouped into six categories based on the type of imaging examination they underwent prior to cholecystectomy: initial US evaluation only (n=80, 68.4%), initial US followed by HIDA (n=17, 14.5%), initial HIDA only (n=2, 1.7%), initial HIDA followed by US (n=3, 2.6%), initial CT (n=5, 4.3%), and no imaging evaluation (n=10, 8.6%). HIDA scan had a calculated sensitivity of 90.9% (20 true-positive, 2 false-negative) while US had a sensitivity of 62% (62 true-positive, 38 false-negative). Current practice in the initial radiological evaluation of acute cholecystitis remains outdated. The vast majority of patients in our study group were initially worked up using US, although HIDA scan has been shown to have greater sensitivity for the diagnosis of acute cholecystitis.     

老年急性胆囊炎患者行腹腔镜胆囊切除术的治疗体会(附50例报告)

目的:探讨为老年急性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床效果。方法:回顾分析2006年10月至2008年10月为50例老年急性胆囊炎患者行LC的临床资料。结果:47例成功施行LC,手术时间35～155min,平均65min,术后1～3d恢复进食,术后住院3～10d,平均6d;腹腔镜下行胆囊造瘘术1例;中转开腹2例,手术成功率94%。1例术后并发肺内感染,经对症治疗后痊愈。无死亡病例及胆漏、出血等术后并发症发生。结论:只要病例选择得当,LC可作为治疗老年急性胆囊炎的理想术式。     

结石性胆囊炎腹腔镜与开腹胆囊切除术的对照研究

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与开腹胆囊切除术(open cholecystectomy,OC)治疗结石性胆囊炎的疗效及并发症.方法:将343例结石性胆囊炎患者分为两组,220例行LC,123例行OC,观察两组手术时间、术中出血量、术后疼痛时间、肛门排气、术...     

Medical versus surgical management of biliary tract disease in pregnancy

BACKGROUND: The management of symptomatic cholelithiasis during pregnancy remains controversial. We compared outcomes after medical versus surgical management of biliary tract disease in pregnant patients. METHODS: We reviewed the clinical course of patients with symptomatic cholelithiasis during pregnancy from 1992 to 2002 at two university hospitals. RESULTS: Seventy-six women with 78 pregnancies were admitted with biliary tract disease. Of the 63 women who presented with symptomatic cholelithiasis, 10 underwent surgery while pregnant. There were no deaths, preterm deliveries, or intensive care unit admissions. Fifty-three patients were treated medically. Their clinical courses were complicated by symptomatic relapse in 20 patients (38%), by labor induction to control biliary colic (8 patients), and by premature delivery in 2 patients. Each relapse in the medically managed group accounted for an additional five days in hospital. CONCLUSION: Surgical management of symptomatic cholelithiasis in pregnancy is safe, decreases days in hospital, and reduces the rate of labor induction and preterm deliveries.