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排序方式: 共有3034条查询结果,搜索用时 31 毫秒
1.
目的:分析腹腔镜胆囊切除术的临床疗效,分析其对血清应激指标的影响。方法:将160例来我院行胆囊切除术的患者随机分为两组,对照组和观察组各80例。对照组采用开腹胆囊切除术,观察组则采用腹腔镜胆囊切除术。比较两组间手术时间、术中出血量、肠功能恢复时间以及住院天数差异,比较治疗前后两组患者间血清应激相关指标皮质醇(COR)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、多巴胺(DA)以及胰岛素(INS)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素释放激素(TSH)水平差异。结果:观察组患者手术时间、术中出血量、肠功能恢复时间以及住院天数均显著少于对照组(P<0.05)。血清COR、NE、ACTH、DA和INS、T3水平在围手术期均发生了显著变化,各项指标均在胆囊分离时就明显升高,术后24 h开始下降(P<0.05);术后观察组上述指标均显著低于对照组(P<0.05)。结论:腹腔镜胆囊切除术对机体应激反应影响小于开腹手术,更利于患者术后康复。 相似文献
2.
目的:探讨腹腔镜胆囊切除术(LC)中意外胆囊癌(unexpected gallb ladder carc inom a,UGC)的处理措施。方法:回顾分析本院955例LC术中遇到的12例(1.26%)UGC的临床资料。结果:随诊3~36个月,平均18个月。迄今全部存活。5例PT1、5例PT2、1例PT3(中转开腹)随访至今未发现癌复发及转移。1例PT2因拒绝根治术,现出现肝多发转移。1例PT4因腹腔种植转移,无法根治,故仅部分切除胆囊(胆囊粘连重),以解决急性胆囊炎问题,现有腹水、恶液质表现。所有病例均未见脐部戳孔处肿瘤种植转移。结论:LC术中应常规切开胆囊标本,必要时送术中冰冻。PT1单纯切除胆囊已足够;PT2要额外楔形切除肝组织及区域淋巴结;PT3中转开腹,行根治手术或姑息手术。 相似文献
3.
Laparoscopic cholecystectomy and time-course changes in renal function 总被引:13,自引:3,他引:10
Y. Miki K. Iwase W. Kamiike E. Taniguchi K. Sakaguchi J. Sumimura H. Matsuda I. Nagai 《Surgical endoscopy》1997,11(8):838-841
Background: Recently, the retraction method has been used to reduce intraabdominal pressure (IAP) during laparoscopic surgery. The purpose
of this study was to determine the serial changes in renal function during laparoscopic cholecystectomy (LC) using the retraction
method.
Methods: Urine output, effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) were measured serially in seven patients
who underwent LC with 12 mmHg pneumoperitoneum (High-IAP group) and five who underwent LC using the retraction method with
4 mmHg pneumoperitoneum (Low-IAP group).
Results: Urine output, ERPF, and GFR were decreased during pneumoperitoneum in the High-IAP group, whereas no significant changes
in any of these parameters were observed in the Low-IAP group.
Conclusions: Our findings demonstrate that reduction of IAP to 4 mmHg using the retraction method prevents the transient renal dysfunction
caused by prolonged 12 mmHg pneumoperitoneum during LC, suggesting that the retraction method reduces the risk of perioperative
renal dysfunction during laparoscopic surgery.
Received: 26 March 1996/Accepted: 27 July 1996 相似文献
4.
Kamil Torres Anna Torres Grzegorz J. Staśkiewicz Andrzej Chrościcki Tadeusz Łoś Ryszard Maciejewski 《Surgical endoscopy》2009,23(9):2117-2123
Background Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal
role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation.
The purpose of the study was to access the influence of low-pressure CO2 pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy.
Methods The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO2 pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and
endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent
assay (ELISA).
Results Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the
groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower
in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed
in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or
by age, gender, or body mass index (BMI) of the patients.
Conclusions The results obtained in our study do not show any significant differences between studied operative procedures with regards
to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population
may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences
and implications. 相似文献
5.
基层医院腹腔镜胆囊切除术1696例的治疗体会 总被引:1,自引:0,他引:1
目的:探讨腹腔镜在基层医院普及开展的可行性和主要并发症的预防。方法:回顾分析1999年6月至2006年5月我院1 696例腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料。结果:1 696例LC成功1 635例,中转开腹61例,中转率3.6%,发生并发症17例,其中胆管损伤1例,腹腔内出血2例,胆漏2例,腹腔感染1例,胆管残石3例,遗漏腹腔内病变6例,上消化道出血2例。结论:LC在基层医院的开展日益成熟,成为治疗胆囊良性疾患的“金标准”。术前注意鉴别诊断,术中操作轻柔,辨明胆囊三角结构,能避免严重并发症的发生。 相似文献
6.
7.
8.
小切口胆囊切除术108例临床观察 总被引:1,自引:0,他引:1
本文报告腹部切口5-8cm的小切口胆囊切除术108例,与同期大切口胆囊切除术相比,具有创伤较小、恢复较快、并发症少、切口疤痕小的优点,虽不如腹腔镜胆囊切除术(LC)的疼痛轻、恢复快,但并症比LC少,只要适应症选择得当,在术者的经验和技术较成熟的情况下,不昔为一种可供选择的方法。 相似文献
9.
Ch. Madl G. Grimm R. Mallek B. Schneeweiß W. Druml A. N. Laggner K. Lenz 《Intensive care medicine》1992,18(4):245-246
In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation. 相似文献
10.