腹腔镜胆囊切除术7032例临床分析

目的探讨腹腔镜胆囊切除术的手术原则及并发症的预防。方法收集我院1995~2005年完成的7 032例腹腔镜胆囊切除术的临床资料,分析行腹腔镜胆囊切除术的原发疾病种类及术后并发症。结果7 032例腹腔镜胆囊切除术病人中最多的原发疾病为胆囊结石合并慢性胆囊炎,手术后并发症中,术后胆管损伤9例,发生率0.07%,术后出血4例,发生率0.06%,术后胆漏3例,发生率0.04%。结论腹腔镜胆囊切除术充分体现了微创外科的优点,但其操作仍较复杂,实行严格的岗前培训和准入制可避免并发症的发生。     

腹腔镜下切除急性坏疽性胆囊致胆管损伤的临床分析

目的探讨腹腔镜下切除急性坏疽性胆囊术中避免损伤胆管的可行性分析及手术技巧。方法回顾性分析湖北省中西医结合医院普通外科收治的168例急性坏疽性胆囊炎病人的临床资料。结果156例病人行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),10例病人行腹腔镜下胆囊大部分切除术。1例Mirizzi综合征病人术中出现胆总管损伤中转开腹行胆肠吻合术。1例病人术中误扎胆总管,再次手术行胆肠吻合术。结论急性坏疽性胆囊炎病人术前给予充分评估,术中掌握操作要点可有效避免胆管损伤等并发症。     

腹腔镜胆道手术的体会

行腹腔镜胆造手术２１５例，其中胆囊结石或胆囊息内样病变２０７例，其余８例的胆囊胆总管结石，在腹腔镜胆囊切除的同时，２例经胆囊管取石，６例行胆总管切开取石Ｔ管引流术。２０７例单纯胆囊切除术者，中转开腹手术３例（１．４％）；发生手术并发症３例（１．４％），其中术后胆漏１例、副肝管损伤１例、胆总管残余结石１例，均经开腹手术治愈。实践证明腹腔镜胆囊切除术是安全可行的，并发症的发生率可以不高于开腹手术，而且具有创伤小、痉疡轻、康复快等优点。作者就腹腔镜胆囊切除术中如何提高手术成功率、降低并发症发生率及腹腔镜治疗胆管结石等方面介绍了自己的体会。     

萎缩性胆囊炎并胆囊结石的腹腔镜治疗临床分析

目的探讨腹腔镜手术治疗萎缩性胆囊炎合并胆囊结石的可行性和手术并发症的防治措施。方法 44例萎缩性胆囊炎合并胆囊结石患者中,28例实施腹腔镜下胆囊切除术(LC),16例实施腹腔镜下胆囊次全切除术(LSC)。结果 28例LC中4例中转开腹,2例胆总管损伤,2例术中出血,1例术后漏胆,2例发生继发性总胆管结石。16例LSC均顺利完成,术后漏胆1例,继发性胆总管结石1例。随访6~32个月,均未出现其他并发症。结论腹腔镜手术治疗萎缩性胆囊炎合并胆囊结石,创伤小、安全性高,合理选择术式、术中规范操作,是保证手术成功的关键。     

腹腔镜胆囊切除术中胆管损伤冈素及预防的体会

自从Mouretl987年完成首例LC，LC手术已成为治疗胆囊结石以及胆囊良性疾病的首选方法和金标准。但腹腔镜胆道手术并发症也越来越被内镜外科医生所重视．胆道损伤是LC最主要的并发症．据刘允怡报道．在12500例LC研究中．胆管损伤发生率为0．85％。2000年1月至2005年9月．笔者行腹腔镜胆囊切除术580例．胆道损伤5例。其中胆总管横断1例．胆总管部分损伤4例。现结合文献将胆管损伤因素及预防的体会报告如下。     

胆管损伤替代性组织修复的再认识

胆管损伤是胆囊切除，尤其是腹腔镜胆囊切除常见的严重并发症，欧美国家报告发生率为0．3％～0．6％。日本统计胆管损伤的发生率为1．7％。我国胆囊结石病人之多，胆囊切除术普及之广，尤其是腹腔镜胆囊切除的蓬勃开展，手术医师素质差异之大，估计我国实际胆管损伤率比文献及会议报道为多。     

腹腔镜顺逆结合胆囊切除术预防胆管损伤的临床分析

目的 探讨腹腔镜顺逆结合胆囊切除术预防胆管损伤并发症的临床价值.方法 回顾性分析1991年3月-2006年6月间腹腔镜顺逆结合胆囊切除术613例的临床资料.结果 613例中胆囊结石伴胆囊萎缩121例,急性、亚急性胆囊炎432例,胆囊结石伴慢性胆囊炎42例,胆囊息肉18例.中转开腹9例,（5例为胆囊结石伴胆囊萎缩,4例亚急性胆囊炎）.平均手术时间43.5 min,术后仅1例发生毛细胆管漏,经引流3d痊愈,其余患者均顺利恢复,无胆管损伤病例,无出血、感染及死亡等严重并发症发生.平均术后住院日5.5 d.结论 腹腔镜顺逆结合胆囊切除术能提高腹腔镜胆囊切除术的成功率,减少了腹腔镜胆囊切除术胆管损伤并发症的发生,特别是Calot三角解剖不清或变异时,此手术方法更有效.     

9例腹腔镜胆囊切除术后再手术原因分析

目的：探讨腹腔镜胆囊切除术（LC）再手术原因及预防措施。方法：回顾分析我院1994年6月至2000年6月760例腹腔镜胆囊切除术后再手术的9例临床资料。结果：9例中胆管损伤3例，胆总管结石2例，胆瘘2例，出血2例。再手术率为1．18％。再手术的方法：胆总管探查、取石、T管引流2例，胆囊管、副肝管、胆囊动脉结扎术4例，胆总管原位吻合、T管支撑引流1例，胆肠吻合2例。9例全部治愈。结论：胆管损伤、胆瘘、胆道出血及胆管残余结石等并发症是腹腔镜胆囊切除术后再手术的根本原因；其次是术式选择不当，手术时机不当，初期技术操作不熟练以及未重视术中胆道造影的重要性所致。     

腹腔镜胆囊切除术胆道损伤原因及手术操作要点

我院自１９９２年１０月～１９９５年１１月共实施腹腔镜胆囊切除术５０００例，发生特殊并发症１６例，发生率０．３％，其中２例胆道损伤１３例胆瘘（包括胆囊床迷走胆管瘘１例，胆总管下端结石并胆管瘘１例）１例术后胆囊动脉出血。为降低手术并发症，掌握术中操作要求，作者认为注意以下四点（１）从事腹腔镜囊切除术须有一定的资历的外科医师担任，并有一定的胆道解剖知识和识别胆道变异能力；（２）全面详细的术前检查及严格选     

术中胆道造影在急诊腹腔镜胆囊切除术中的应用价值

目的 探讨经胆囊管术中胆道造影在急诊腹腔镜胆囊切除术中的价值.方法 对95例急性胆囊炎胆囊结石患者行急诊腹腔镜胆囊切除术,术中行经胆囊管胆道造影,对胆总管结石、胆囊管结石的发生率及发现胆管误伤和解剖变异情况进行回顾性分析.结果 经术中胆道造影发现胆总管结石11例、胆囊管结石6例、迷走胆管1例、肝总管损伤1例、Mirizzi综合征2例、胆道变异2例.结论 经胆囊管术中胆道造影在急诊腹腔镜胆囊切除术中可发现术前未发现的胆总管、胆囊管结石,指导治疗,减少术中胆管损伤,及时发现胆管损伤并正确处理,减轻急性炎症带来的手术困难.     

Laparoscopic cholecystectomy

From November 1990 to April 1994 we attempted laparoscopic cholecystectomy (LC) in 1,788 consecutive patients. The intraoperative findings related to gallbladder's pathology were as following: chronic cholecystitis in 792 patients (44.3%), simple cholecystolithiasis in 760 (42.5%), acute cholecystitis in 98 (5.5%), hydrops in 44 (2.5%), empyema in 38 (2.1%), gangrenous cholecystitis in 12 patients, acalculous cholecystitis in 20 patients, polyps in 11 patients, adenomyomatosis in 9 patients, and gallbladder's carcinoma in 4 patients. Although we had a considerable number of cases with severe inflammation and/or dense adhesions the conversion rate to open surgery was relatively low (2.5%). There was no procedure-related mortality and no common bile duct injury. Postoperative complications occurred in 58 patients (3.2%). Bile leak was present in 19 patients, retained bile duct stones in 8, severe bleeding in 6, mild pancreatitis in 4, pulmonary embolism in 1, cerebral bleeding in 1, wound infection in 6, abdominal wall hematoma in 4, and umbilical incisional hernia in 2; 7 patients presented other minor complications. The mean postoperative hospital stay of our patients was 1.8 days (range 1–12 days). Adequate measures to prevent intraoperative accidents, meticulous technique, and full maintenance of the equipment are among the most important factors in keeping a low conversion and complication rate in the patients undergoing LC.     

腹腔镜下复杂胆囊三角的处理体会(附668例报告)

目的:探讨腹腔镜下复杂胆囊三角的处理技巧。方法:回顾分析2000年2月至2011年10月为668例复杂胆囊患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料,对萎缩性胆囊炎、胆囊管结石、急性胆囊炎等复杂情况采取相应的手术技巧,细致解剖胆囊三角。结果:644例顺利完成LC;24例中转开腹,其中Mirizzi综合征Ⅱ～Ⅳ型5例,胆囊三角致密粘连15例,胆囊十二指肠内瘘2例,胆管损伤行胆管修复及T管引流2例,分别于术后6个月、12个月拔除T管。16例术后发生胆漏,均保守治愈。术后随访,无严重并发症发生。结论:腹腔镜复杂胆囊切除术中细致解剖胆囊三角是手术成功的关键,胆囊三角致密粘连、Mirizzi综合征Ⅱ型～Ⅳ型或内瘘形成等是中转手术的指征。     

急性结石性胆囊炎腹腔镜胆囊切除术127例报告

目的:探讨急性结石性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)手术时机的选择及术中并发症的预防.方法:回顾分析2008年1月至2011年6月为127例急性结石性胆囊炎患者施行LC的临床资料.结果:125例顺利完成LC,2例中转开腹.术后继发胆管结石3例,均于术后3～5d行...     

腹腔镜术中胆道造影398例分析

目的探讨腹腔镜术中胆道造影对腹腔镜胆囊切除术的应用价值。方法回顾性分析近8年间398例腹腔镜术中胆道造影者的临床资料。结果发现胆总管结石40例，胆囊管内结石3例，胆道畸形54例，胆道损伤6例。均予相应治疗，无死亡。结论腹腔镜术中胆道造影的临床应用能显著降低胆道结石残留和及时发现胆道损伤等严重并发症。     

急性胆囊炎腹腔镜胆囊切除术420例报告

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎的可行性及安全性。方法:回顾分析2000年2月至2011年8月为420例急性胆囊炎患者行LC的临床资料。结果:402例顺利完成LC。18例中转开腹行胆囊切除术,其中Mirizzi综合征5例,胆囊三角"冰冻样"粘连12例,1例胆总管损伤行胆管修补及T管引流术,术后6个月拔除T管。5例术后发生胆漏,均保守治疗痊愈。术后随访6～12个月,无胆管狭窄、胆管残余结石、残余小胆囊等严重并发症发生。结论:只要术者熟练掌握操作技巧,提高术中应变能力,为急性胆囊炎患者行LC是安全可行的。     

基层医院腹腔镜胆囊切除术1696例的治疗体会

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。     

基层医院腹腔镜胆囊切除术1 696例的治疗体会

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.     

Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy

BACKGROUND: Laparoscopic cholecystectomy (LC) is the preferred treatment for gallstone disease, even in many complicated cases. Perhaps the only downside to LC is a two- to threefold increase in common bile duct (CBD) injuries compared with open cholecystectomy (OC). Intraoperative cholangiography may prevent inj uries, but its routine use remains controversial. Our institution adopted a policy of selective intraoperative cholangiography in 1993. When intraoperative laparoscopic ultrasonography (IOUS) emerged as a viable diagnostic adjunct, it was hypothesized that the routine use of IOUS would facilitate dissection, detect occult choledocholithiasis, and prevent bile duct injuries during LC. STUDY DESIGN: The experience with LC at our university-affiliated teaching hospital was reviewed. Over a 4 1/2-year period (June 1, 1995, to January 31, 2000), two surgeons used IOUS routinely during LC (ultrasonography [US] group, n = 248); three other surgeons did not (non-US group, n = 594). We compared patient data and outcomes between the two groups. Continuous, data are expressed as mean +/- SEM. RESULTS: During the study period, 842 LCs were attempted. Patient age (37+/-1 years) and gender (85% female) did not differ between the groups. In the US group, more patients had acute cholecystitis (p < 0.05). More LCs were performed per year by non-US surgeons than US surgeons (45 versus 37). Despite this, all bile duct complications occurred in non-US cases (2.5% overall): five CBD injuries (0.8%), six bile leaks (1%), and four retained CBD stones (0.7%). In the subgroup of patients with acute cholecystitis, there were fewer conversions to OC in US compared with non-US cases (24% versus 36%, p = 0.09). CONCLUSIONS: IOUS is noninvasive, fast, repeatable, and can corroborate real-time visualization of the operative field. We have found that LC with IOUS is associated with fewer bile duct complications (CBD injuries, bile leaks, and retained CBD stones) than LC without adjunctive imaging. The success rate of LC in cases of acute cholecystitis is slightly higher when IOUS is used as an aid to dissection. In the absence of definitive prospective data, we recommend routine use of IOUS when performing LC, particularly in patients with acute cholecystitis.     

“三孔一勾到底法”腹腔镜胆囊切除术1260例临床总结

目的总结1 260例＂三孔一勾到底法（TOE）＂腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的经验,探讨其手术方式、技术要点及并发症的预防。方法回顾性分析我院1999年3月至2008年3月期间应用TOE治疗慢性结石性胆囊炎、急性结石性胆囊炎、萎缩性胆囊炎、胆囊息肉等病变1 260例患者的临床资料。结果本组1 260例全部治愈,其中1 252例LC成功（99.37%）,中转开腹8例;无死亡病例,无胆管损伤,术中出血3例,脐部感染2例,胆囊窝积液3例;手术时间8~60 min,平均38.5 min;住院时间3~7 d,平均5 d。1 002例随访1~7年,平均3.5年,未发现胆瘘、胆管残留结石、胆管狭窄等并发症。结论TOE操作规范,手术效果好,并发症少,恢复快,安全有效,值得应用及推广。