腹部手术后腹腔镜胆囊切除术210例分析

随着腹腔镜技术的普及和操作经验的积累,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的适应证不断扩大,有过腹部手术史的患者也能得益于腹腔镜技术而痊愈.我院自2001年3月开展LC以来,共完成1 000例,其中有腹部手术史210例,占21%,临床效果满意,现报道如下.     

上腹部手术后腹腔镜胆囊切除术

目的探讨上腹部手术后腹腔镜胆囊切除术(LC)的可能性及手术方法与技巧。方法回顾性分析我院2005～2009年期间对有上腹部手术史行LC的23例患者的临床资料。结果 23例患者中慢性结石性胆囊炎18例,胆囊息肉5例。既往均有上腹部手术史,其中胃大部切除术后19例,胃平滑肌瘤切除术后2例,脾破裂修补术后2例。采用闭合法穿刺建立气腹,分离粘连,暴露胆囊全貌及Calot三角,顺行或逆行切除胆囊。23例中LC成功21例;因粘连致密,胆囊管无法辨认,中转开腹2例。手术时间45～140min,平均67min.全组无明显出血、内脏损伤、胆管损伤、胆汁漏等并发症发生。结论部分上腹部手术后胆囊良性疾病行LC术可行。     

腹部手术后腹腔镜胆囊切除术52例报告

目的:探讨有腹部手术史患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及治疗经验.方法:回顾分析2010年11月至2011年5月为956例患者施行三孔法LC的临床资料,其中52例有腹部手术史(实验组),904例无腹部手术史患者为对照组.两组患者均于气管插管全麻下施术.结果...     

多次上腹部手术后腹腔镜胆囊切除术22例分析

目的 探讨多次上腹部手术后腹腔镜胆囊切除(LC)的可能性及手术方法及技巧。方法 回顾性分析22例多次(≥2)上腹部手术后LC。结果 LC成功15例,成功率68.2％(15/22)。其中2次上腹部手术后LC成功率63.6％(14/22),3次上腹部手术后LC成功率为1例。7例中转开腹,无手术并发症发生。结论 多次上腹部手术史不应成为LC的禁忌症,但手术难度大,中转开腹手术率增高。     

多次上腹部手术后腹腔镜胆囊切除术

目的　探讨多次上腹部手术后腹腔镜胆囊切除术 (LC)的可行性及特点。　方法　连续进行 35例多次 (≥ 2次 )上腹部手术后LC。　结果　LC成功 2 1例 ,成功率 6 0 0 % (2 1 35 )。 2次上腹部手术后LC成功率 6 2 5 % (2 0 32 ) ,3次上腹部手术后LC成功率为 1 3。 14例中转开腹 ,中转率 4 0 0 % ,平均手术时间 6 8 7min ,中转率与手术时间均明显高于同期无上腹手术病史患者。无手术并发症发生。　结论　多次上腹部手术史不应成为LC的禁忌证 ,但手术难度加大 ,中转率增高 ,手术时间延长 ,对手术医师的要求较高。     

合并上腹部手术史的腹腔镜胆囊切除术操作体会

腹部手术史尤其上腹部手术史一直是腹腔镜胆囊切除术的相对禁忌症之一[1],主要原因是该类患者腹腔内常存在较为广泛且致密的粘连,导致镜下分离松解困难,分离过程中容易发生意外出血及胃肠、胆管等重要脏器损伤,     

有上腹部手术史患者行腹腔镜胆囊切除术临床分析

目的探讨有上腹部手术史患者行腹腔镜胆囊切除术（LC）的可行性、安全性及应用价值。方法回顾分析2008年1月至2011年12月32例有上腹部手术史患者行LC的临床资料,并探讨操作技巧。结果手术均成功完成,无中转开腹,患者均治愈。结论有上腹部手术史者行LC是安全可行的,术者和持镜者需密切配合,术者需要有较高的腹腔镜操作水平及经验。     

原发性腹腔广泛粘连对腹腔镜胆囊切除术的影响

目的:探讨为原发性腹腔广泛粘连患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及效果。方法:回顾分析2001年1月至2009年9月29例LC术中遇原发性腹腔广泛粘连患者(A组)的临床资料,并与随机选择的同期行LC无腹部手术史的120例患者(B组)对比分析。结果:两组均无中转开腹及手术并发症发生,平均住院时间、术中出血差异无统计学意义,A组手术时间较B组长。结论:原发性腹腔广泛粘连患者行LC安全、有效,可作为首选术式。     

腹腔镜胆囊切除术治疗复杂胆囊疾病的临床分析

本文就我院 1997年 11月至 2 0 0 1年 3月所施行的单纯胆囊疾病腹腔镜胆囊切除术 (简称单纯LC)和复杂胆囊疾病LC(复杂LC)及复杂胆囊疾病开腹胆囊切除术 (复杂OC)所发生的并发症及胆管损伤 (BDI)等情况予以分析讨论 ,以便正确评价LC在治疗复杂胆囊疾病中的疗效和地位。资料与方法1.一般资料 :本组 5 37例 ,男 15 8例 ,女 379例。年龄 18～ 76岁 ,平均 4 6 8岁。所有病例均经手术或病理检查证实。其中单纯胆囊疾病 (包括胆囊息肉及Calot三角解剖清晰的各种胆囊结石等 )行LC 35 0例 ;复杂胆囊疾病 (包括急性胆囊炎胆石症、萎缩性胆囊炎…     

上腹部手术史腹腔镜胆囊切除术52例分析

上腹部手术后形成的粘连对LC有明显的影响，上腹部手术后的腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）属于困难的腹腔镜手术，常被认为是LC的禁忌证。随着腹腔镜器械的不断改进和腹腔镜操作技巧的提高，这已不再作为手术绝对禁忌证。我院1994年开展LC，2002年1月-2007年10月为有上腹部手术史的52例实施LC，现报道如下。     

Laparoscopic cholecystectomy in patients with previous abdominal surgery.

BACKGROUND: Laparoscopic cholecystctomy has become the treatment of choice for symptomatic gallstones. The potential risks have dissuaded some surgeons from using the laparoscopic procedure in patients with previous abdominal surgery. Therefore, we aimed to investigate the effect of previous abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. METHODS: This study included 600 well-documented patients with gallstones who underwent laparoscopic cholecystctomy at our surgical department between May 2000 and January 2004. The patients were classified into 3 groups: group 1, patients without a history of previous abdominal surgery (n = 408); group 2, patients with a history of upper abdominal surgery (n = 92); group 3, patients with a history of lower abdominal surgery (n = 100). The data were collected and analyzed for open conversion rates, operative times, perioperative and postoperative complications, and hospital stay. RESULTS: Of the 600 study patients, 192 had undergone previous abdominal surgery (92 upper, 100 lower). Conversion rate, hospital stay, and complication rates were similar in each group. Mean operating time was the longest (57 +/- 9.8 min) in patients with previous upper abdominal surgery (P < 0.05). On the other hand, the operative time was similar in groups 1 and 3 (P > 0.05). CONCLUSION: Previous abdominal surgery is not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with a prolonged operation time.     

开腹手术后的腹腔镜胆囊切除手术

目的 探讨有腹部手术史的病人行腹腔镜胆囊切除术的某些特点。方法 回顾分析34例有腹部手术史的患行腹腔镜胆囊切除术的临床资料。结果 34例中33例顺利完成腹腔镜胆囊切除术，仅1例中转开腹手术。结论 对有腹部手术史的病人行腹腔镜胆囊切除术是可行的，但穿刺孔选择、气腹、粘连的分离应予以注意。     

Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery

Background: Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. This study specifically examined the effect of previous intraabdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. Methods: Data from 1,638 consecutive patients who underwent laparoscopic cholecystectomy were reviewed and analyzed for open conversion rates, operative times, intra- and postoperative complications, and hospital stay. Results: Of the 1,638 study patients 473 (28.9%) had undergone previous abdominal surgery: 58 upper and 415 lower abdominal operations. The 262 patients who had undergone only a previous appendectomy were excluded from further analysis. Adhesions were found in 70.7%, 58.8% and 2.1% of patients respectively, who had previous upper, lower or no previous abdominal surgery with adhesiolysis required, respectively, in 78%, 30% and 0% of these cases. There were no complications directly attributable to adhesiolysis. Patients with previous upper abdominal surgery had a longer operating time (66.4 ± 34.2 min), a higher open conversion rate (19%), a higher incidence of postoperative wound infection (5.2%), and a longer postoperative stay (3.4 ± 2.1 days) than those who had undergone previous lower abdominal surgery (50.8 ± 24 min, 3.3%, 0.7%, and 2.6 ± 1.4 days, respectively) and those without prior abdominal surgery (47.4 ± 25.6 min, 5.4%, 1.2%, and 2.8 ± 1.9 days, respectively). Conclusions: Previous abdominal operations, even in the upper abdomen, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a higher open conversion rate, a prolonged operating time, an increased incidence of postoperative wound infection, and a longer postoperative stay.     

Laparoscopic cholecystectomy in cirrhotic patients

Background: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis. Methods: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child–Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed. Results: No deaths occurred. Conversion to open cholecystectomy was necessary in two cases. The average operative time was 115 min, which was significantly shorter than that for patients undergoing open cholecystectomy. None of the patients required blood transfusion. Intraoperative problems occurred in two patients who experienced liver bed bleeding. Postoperative morbidity occurred in 36% of the patients and included hemorrhage, wound complications, intraabdominal collections, and cardiopulmonary complications, but all were controlled. The patients were dismissed after an average of 4 days. Conclusion: The authors believe laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child–Pugh A and B who manifest indication for surgery. Laparoscopic cholecystectomy offers several advantages over open cholecystectomy: lower morbidity, shorter operative time, and reduced hospital stay.     

Laparoscopic cholecystectomy in geriatric patients

BACKGROUND: The results and advantages of laparoscopic cholecystectomy in the geriatric population have received minimal attention. Several early reports related high conversion rates complications and mortality. This case series review is focused on the results of laparoscopic cholecystectomy in the geriatric population in a private practice environment. METHODS: The records of all patients undergoing cholecystectomy by the author over the past 12 years were reviewed. The entire series consists of 248 patients in whom 239 procedures were completed laparoscopically, with 9 patients converted to an open cholecystectomy. This report identifies 82 patients who were aged 65 years or older at the time of the laparoscopic cholecystectomy. The results of this series are reported in three progressive geriatric age groups: 65 to 74, 75 to 84, and 85 to 95 years. RESULTS: All 82 geriatric patients reported from this series were symptomatic from their gallbladder disease. A majority of all patients in all age groups were female. Gallstones were present in 77 patients, and 5 patients had a gallbladder ejection fraction of less than 35%. In this series of laparoscopic cholecystectomy, 26.8% had an emergent procedure for acute cholecystitis and the remainder had an elective or semielective procedure for symptomatic cholecystitis. The majority of patients between the ages of 65 and 84 years had elective procedures whereas the majority of patients over age 85 had an emergent procedure. There were 2 deaths. The first death (age 86 years) was from extensive metastatic cancer from the gallbladder, and the second patient (age 91 years) died of sepsis and multiple system organ failure. Each patient in this entire series had an attempt at laparoscopic removal of the gallbladder. The conversion rate was 3.6% in the entire series of 248 patients and also 3.6% in the geriatric series. Ninety-one percent of the patients in this geriatric series were discharged home after only 24 to 48 hours of postoperative observation. CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in the geriatric population. The procedure should be recommended for all geriatric patients who have symptomatic cholecystitis before the development of acute cholecystitis or severe fibrosis with dense adhesions from chronic cholecystitis.     

Laparoscopic cholecystectomy using a newly developed laparoscope manipulator for 10 patients with cholelithiasis

Background Laparoscopic surgery has continued to gain popularity in almost all fields of abdominal surgery, and robotic systems have been introduced in general surgery. Naviot is a new remote-controlled laparoscope manipulator system controlled by the operator’s hand. This study assessed its introduction into clinical practice. Methods A group of 10 consecutive patients with cholelithiasis underwent laparoscopic cholecystectomy assisted by the Naviot system (Naviot group). Another group of 41 patients who underwent laparoscopic cholecystectomy with a conventional human camera holder (human camera group) were selected for a comparison of their operative results with those of the Naviot group. Results The operative time of 89.3 ± 27.1 min for the Naviot group was significantly longer than that of 74.8 ± 28.1 min for the human camera group (p < 0.05). However, when the setup time for the Naviot system was excluded, the operative time was not significantly different from that for the human camera group. Other operative results showed no significant difference between the two groups. Conclusions The authors believe that the new Naviot system is feasible for clinical use, and that it enables surgeons to perform solo gastrointestinal surgery.     

Laparoscopic Cholecystectomy with Previous Gastrectomy

ABSTRACT

Introduction: To evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) in patients with a history of gastrectomy. Methods: The clinical data of 9,403 consecutive patients who underwent LC from January 2003 to September 2010 in our hospital were retrospectively analyzed; 30 of them had undergone previous gastrectomy. We compared the operative duration, hospitalization, and conversion rate between patients with, and those randomized selected patients without, a history of gastrectomy. Results: All patients were treated by laparoscopic procedure successfully. The mean operative duration (55.00 min vs. 29.63 min, P < .05) and mean hospitalization duration (4.57 days vs. 3.00 days, P < .05) were significantly longer in the patients with a history of gastrecotomy. There are no complications such as bile duct and bowel injury in control group, however two bile duct injuries emerged in the observed group, which required surgical intervention. Conclusions: Although the operation is difficult, LC is a safe and effective treatment for the patients with a history of gastrectomy.     

肝硬化门脉高压病人的腹腔镜胆囊切除术(附48例报告)

目的探讨肝硬化门脉高压(CPH)下的腹腔镜胆囊切除的可行性与技术特点。方法回顾性分析48例CPH下的腹腔镜胆囊切除(LC)处理过程。结果45例顺利完成LC，3例转开腹手术，因术中出血2例，胆囊三角粘连暴露困难1例。术中出血10～300ml，平均手术时间为42分钟。术后发生并发症10例次，均治愈出院。结论CPH下行LC是可行安全的。掌握手术的技术特点，使用超声刀，注意围手术期的处理，是成功的关键。     

老年急性胆囊炎腹腔镜胆囊切除术

目的总结老年急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）经验。方法回顾性分析279例LC临床资料，其中急性结石性胆囊炎263例，单纯胆囊腺瘤8例，单纯胆囊息肉样病变5例，无明显原因3例。结果LC手术成功率87．5％（244／279），中转开腹手术35例，无严重并发症，无手术死亡。结论老年人常合并其他脏器疾病，LC围手术期危险性增高，应严格掌握手术适应证，正确处理合并症，术中放宽中转开腹指征是预防和减少并发症的关键。