腹腔镜手术与开腹手术治疗胆囊炎、胆结石的疗效比较

Objootive To explore the curative effect difference of laparoscopic cholecysteetomy and open cholecystectomy on patients with eholecystitis and/or gallstone.Methods The clinical efficacy data of 86 patients with cholecystitis and/or gallstone underwent laparoscopic cholecystectomy in our hospital from Jan.2007 to Dec.2009 was retr~pectively analyzed,and compare with clinical efficacy data of 86 cases underwent open cholecystectomy before this time.Results There's significant difference on surgical operation time,bleeding volume,and postoperative complications between the laparoscopic cholecvsfeetomy group and the open cholecystectomy group(P＜0.05).Condusion Laparoscopie cholecystectomy is a safe and effective method for acute cholecystitis,and woah for spread application.     

腹腔镜手术与开腹手术治疗胆囊炎、胆结石的疗效比较

Objootive To explore the curative effect difference of laparoscopic cholecysteetomy and open cholecystectomy on patients with eholecystitis and/or gallstone.Methods The clinical efficacy data of 86 patients with cholecystitis and/or gallstone underwent laparoscopic cholecystectomy in our hospital from Jan.2007 to Dec.2009 was retr~pectively analyzed,and compare with clinical efficacy data of 86 cases underwent open cholecystectomy before this time.Results There's significant difference on surgical operation time,bleeding volume,and postoperative complications between the laparoscopic cholecvsfeetomy group and the open cholecystectomy group(P＜0.05).Condusion Laparoscopie cholecystectomy is a safe and effective method for acute cholecystitis,and woah for spread application.     

腹腔镜手术与开腹手术治疗胆囊炎、胆结石的疗效比较

Objootive To explore the curative effect difference of laparoscopic cholecysteetomy and open cholecystectomy on patients with eholecystitis and/or gallstone.Methods The clinical efficacy data of 86 patients with cholecystitis and/or gallstone underwent laparoscopic cholecystectomy in our hospital from Jan.2007 to Dec.2009 was retr~pectively analyzed,and compare with clinical efficacy data of 86 cases underwent open cholecystectomy before this time.Results There's significant difference on surgical operation time,bleeding volume,and postoperative complications between the laparoscopic cholecvsfeetomy group and the open cholecystectomy group(P＜0.05).Condusion Laparoscopie cholecystectomy is a safe and effective method for acute cholecystitis,and woah for spread application.     

Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury

Roux-en-Y hepaticojejunostomy anastomosis is the treatment of choice for common hepatic duct injury type E2.It has been performed laparoscopically with the advancement of laparoscopic skill.Recently,a telemanipulative robotic surgical system was introduced,providing laparoscopic instruments with wrist-arm technology and 3-dimensional visualization of theoperative field.We present a case of 36-year-old female patient who had undergone elective cholecystectomy2 mo ago for gall stones and had a common bile duct injury during surgery.As the stricture was old and complete it could not be tackled endoscopically.We did a laparoscopic assisted adhesiolysis followed by robotic Roux-en-Y hepaticojejunostomy.No intraoperative complications or technical problems were encountered.Postoperative period was uneventful and she was discharged on the 4th postoperative day.At followup,she is doing well without evidence of jaundice or cholangitis.This is the first reported case of robotic hepaticojejunostomy following common bile duct injury.The hybrid technique gives the patient benefit of laparoscopic adhesiolysis and robotic suturing.     

急性结石性胆囊炎急诊手术与延期手术的疗效比较

Objective Through comparing the curative effects of urgent and delayed laparoscopic cholecystectomy (LC) on acute calculous cholecystitis,evaluating the safety and feasibility of urgent LC for acute calculous cholecystitis.Mthods 109 patients with a clinic diagnosis of acute calculous cholecystitis were randomly assigned to urgent LC (urgent group,n=55) or delayed interval surgery after initial medical treatment (delayed group,n=54,but with some reasons there only 40 patients were treated by delayed surgery).According to the operation time within 72 hours of admission or not,the urgent group was divided into two groups:37 patients in Group Ⅰ (within 72 hours) and 18 patients in Group Ⅱ (beyond 72 hours).The operation time,bile duct injury,conversion to open cholecystectomy,total hospital stay,postoperative complications and mortality of the perioperative period were compared.Results There was no difference between the urgent LC group and delay LC group in the operating time[ (91±26.2 )min versus( 104±34.7 )min],bile duct injury (1 case versus 0 case),conversion to open cholecysteetomy (3case versus 4 case),total hospital stay[ (8±2.7) day versus( 8±1.2 )day]and postoperative complications (2 case versus 1 case).The delay in performing an LC beyond 72 h affected the operating time and conversion to open eholeeystectomy.No death in perioperative period.Conclusion Urgent LC for acute calculous cholecystitis can be performed safely and successfully.Earlier urgent LC has a beneficial impact for patients.     

电子腹腔镜胆囊切除术术后并发症的防治体会

目的：探讨电子腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）并发症的预防和处理。方法：回顾性分析8942例LC并发症种类、处理方法和预防措施。结果：8942例中发生胆管损伤2例,胆总管结石残留3例,胆囊管残端瘘1例,胆囊动脉撕脱出血4例,肠损伤1例。结论：腹腔镜胆囊切除术并发症重在预防,规范的手术程序,适时主动中转开腹是降低LC并发症发生率的关键。     

腹腔镜胆囊切除术与直视微创胆囊切除术的对比研究

目的对腹腔镜胆囊切除术与直视微创胆囊切除术进行对比研究，探讨胆囊切除术适应证患者的理想术式。方法 回顾200例腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）与200例直视微创胆囊切除术的（mini—incision cholecystectomy，MC）临床资料，从手术通应证、术前准备、麻醉选择、手术创伤、并发症等方面对比分析两者的优缺点。结果两者比较LC创伤小、恢复快、并发症较少而MC并发症较多，术后恢复较慢。结论两种方式均具有微创特点，但是LC仍为适应胆囊切除术患者的首选。     

腹腔镜胆囊阑尾联合切除术的护理体会

腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)及腹腔镜阑尾切除术(laparoscopic appendetectomy,LA)已在全国各级医院广泛开展,因其创伤小、恢复快而深受广大患者欢迎[1,2].我院自2004年3月至2006年8月共行腹腔镜胆囊阑尾联合切除62例,取得了良好的效果,现将LC和LA的护理体会总结如下.     

胆囊切除术的治疗体会

Objective To explore the method of cholecystectomy. Methods Chose three different notches to expose the cholecyst as soon as possible, gave different treatment according to pathological changes and prevent the complications. Among the all the eases ,there were 1238 eases of direct and regular eholecysteetomy, 1572 eases of regular cholecystectomy after sever the conglutination and expose the cholicyst. There were still 47 cases with serious conglutination,since their cholecysts were hard to he exposed, irregular cholecystectomy were carried out. Results All the cases recovered and leave the hospital. Conclusions Pure cholecystectomy, estimation of pathological changes and choosing of notches are in favor of exporsing the cholecystectomy clearly and in time and reducing the occurrence of complications.     

腹腔镜胆囊切除术常见并发症的防治体会

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症发生的原因、处理及预防方法.方法:对35例LC并发症的临床资料回顾性分析.结果:胆管损伤6例,术中出血12例,术后胆漏8例,术后出血2例,其他并发症7例,并发症发生率为2.64%.结论:LC是较开腹胆囊切除术更易于发生危险的手术,严格掌握手术适应证,熟练的操作技术,果断中转开腹是防止LC并发症发生的重要措施.     

腹腔镜胆囊切除术并发症的防治体会

目的回顾性探讨腹腔镜胆囊切除术发生并发症的原因及防治方法。方法回顾性分析2004年1月至2009年3月间1749例腹腔镜胆囊切除的并发症及处理措施。其中胆总管横断2例,迷走胆管损伤4例,胆总管夹闭1例,腹腔出血2例,胆总管残余结石2例,胆囊管残端瘘1例。结果本组患者均通过手术治疗或保守治疗治愈出院。结论完善的术前检查,严格规范的操作,胆囊三角良好的显露,辨清肝总管、胆总管和胆囊管之间的关系,及时果断中转开腹,是避免腹腔镜胆囊切除术发生并发症的关键。     

腹腔镜胆囊切除术并发症的分析与防治体会

目的研究分析腹腔镜胆囊切除术(LC)并发症的原因,探讨如何减少和预防腹腔镜胆囊切除术并发症的发生。方法回顾性分析2011年1月至2012年1月351例胆囊疾病患者行腹腔镜胆囊切除术的临床资料。结果 351例腹腔镜胆囊切除术,发生胆漏4例,胆道损伤2例,腹腔出血1例,皮下气肿1例,结石残留2例,腹腔脓肿2例,术后呕吐4例,胆绞痛1例,经采取正确的治疗方法和护理策略,患者均治愈出院。结论严格掌握手术适应证,熟练掌握手术技术,术中仔细操作,特别要注意Calot三角解剖变异,适时中转开腹,术后严密观察病情变化,加强术后护理,及时发现术后并发症并正确处理。     

腹腔镜胆囊切除术胆管损伤的防治体会

目的：探讨腹腔镜胆囊切除术中胆管损伤的原因及防治方法。方法：回顾性分析2004～2006年的527例腹腔镜胆囊切除术,其中胆管损伤6例,包括胆总管横断2例,胆总管夹闭1例,胆囊管残端漏1例,胆囊迷走胆管损伤2例。胆总管损伤患者均行一期手术,胆囊迷走胆管损伤患者置管引流治愈。结果：本组患者1例因发生胆管狭窄后再次手术行Roun-en-y吻合术,其它患者恢复顺利。结论：严格规范的操作,胆囊三角良好的显露,辨清肝总管、胆总管和胆囊管之间的关系,必要时中转开腹,是避免肝外胆管损伤和预防胆漏的关键。     

腹腔镜胆囊切除术2000例适应证与并发症探讨

目的探讨腹腔镜胆囊切除术（LC）的手术适应证及并发症。方法回顾分析2 000例LC患者的临床资料,对其诊治过程、结果及有无并发症等情况进行分析。结果 2 000例腹腔镜胆囊切除术中,1 985例手术顺利结束,15例中转开腹。术后胆囊动脉出血1例,术后残留胆总管结石1例,均治愈,无胆管损伤发生。结论 LC的并发症有胆管损伤、术后出血、胆总管结石残留等。严格掌握LC的适应证,遵循正确的手术操作原则,及时诊断并治疗并发症,是提高治愈率的关键。     

腹腔镜胆囊切除术并发症的防治

目的:探讨如何降低腹腔镜术后并发症,尤其是胆管损伤、胆漏及出血等。方法:对1786例腹腔镜胆囊切除术的资料进行回顾性分析。结果:46例中转开腹;18例出现了不同程度的并发症,其中胆漏5例、出血3例、胆管损伤2例、胆管残余结石4例、胰腺炎3例、切口疝1例,均经再次腹腔镜、开腹或保守治疗痊愈。本组无死亡。结论:术中正确识别与处理变异胆囊管和胆囊动脉,避免电灼损伤周围组织,冷静处理术中出血是减少胆管损伤、胆漏及出血的重要措施。再次腹腔镜手术处理腹腔镜胆囊切除术的并发症是可行的。     

急性炎症期腹腔镜胆囊切除术的临床应用

目的 探讨腹腔镜技术在急性胆囊炎治疗中的处理方法及并发症的防治.方法 回顾分析365例急性炎症期腹腔镜胆囊切除术临床资料及治疗结果.结果 行腹腔镜胆囊切除术365例:成功357例(97.8％),中转开腹8例(2.2％).其中因胆囊与周围组织粘连紧密无法分离而主动中转开腹5例(1.37％);被动中转开腹3例(0.83％),其中肝外胆管损伤2例、胆囊动脉出血l例.结论 急性炎症期腹腔镜胆囊切除术所遇情况复杂多变,随着腹腔镜切除术经验积累,掌握手术技巧,可降低手术难度,减少手术并发症的发生,是安全可行的.     

逆行切除术在困难腹腔镜胆囊切除术中的应用

目的:探讨困难腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)中逆行切除术的手术方法及临床意义.方法:采用逆行切除术的困难LC患者327例临床资料进行回顾性分析.结果:除中转开腹12例外,其余病人均LC成功.结论:困难LC适时选用逆行切除术,可提高腹腔镜手术成功率,减少胆管损伤等并发症的发生.     

腹腔镜胆囊切除术经验总结277例

目的探讨腹腔镜胆囊切除术的经验。方法对重庆江北区中医院277例腹腔镜胆囊切除术的经验做回顾性分析。结果全部病例中,中转开腹手术22例(7.9%),LC成功255例(92.1%),胆道损伤3例(1.1%),无死亡病例。结论认胆囊管与胆总管、肝总管三者关系是避免LC胆道损伤并发症的关键。     

腹腔镜胆囊切除手术并发症的防治体会

目的探讨腹腔镜胆囊切除术(LC)并发症的防治经验。方法回顾性分析1997年4月至2005年5月500例LC的临床资料。结果术后发生出血2例,胆总管残余结石1例,胆瘘3例,腹壁切口感染3例。均经手术及保守治疗治愈。无胆管损伤和死亡病例。结论术中遵循暴露充分,钝性分离,准确识别胆囊壶腹和胆囊管交界部,遇到困难时及时中转手术的原则是减少术后并发症的重要措施。     

困难腹腔镜胆囊切除术处理方法探讨226例报道

目的 探讨困难腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）的处理.方法 总结分析2000年1月-2012年2月226例困难LC的临床资料,探讨降低中转开腹率及减少手术并发症的方法.结果 胆囊颈部和胆囊管结石嵌顿125例,胆囊炎急性发作致胆囊三角解剖关系不清71例,萎缩性结石性胆囊炎30例.中转开腹23例,其中胆囊三角解剖不清无法分离显露10例;急性胆囊炎,胆囊与周围组织致密黏连,无法分离显露胆囊6例;胆囊萎缩、胆囊三角纤维化无解剖层次5例;胆囊床渗血不止2例.术后胆漏2例,经引流胆漏停止10 d后拔除引流管.226例住院时间5~13 d,平均7 d.182例随访3~12个月,无胆道损伤发生.有1例术后2周再次出现腹痛经磁共振检查（MRCP）胆囊管与胆总管汇合位置较低且汇合处胆囊管残留结石嵌顿,经开腹手术取出结石.结论 困难LC,术中充分细致解剖、严密止血、镜下缝合等方法,大多可以安全完成.但对认为不安全的LC及时中转为开腹胆囊切除术,有利于减少或避免并发症的发生.