Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
目的 总结纤维胆道镜对胆道术后残留结石的治疗作用。方法 应用纤维胆道镜治疗胆道术后残留结石108例。结果取石成功率96.9%，结石取净率80.5%。结论 纤维胆道镜对解决胆道术后残留结石有其重要作用，并可降低再手术率。
ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
目的 探讨腹腔镜胆囊切除术(LC)同时同孔完成多脏器手术可能性及手术方法。方法 总结1993年3月至1999年4月完成LC 2 170例，其中LC同时同孔完成多脏器手术51例。结果 该51例手术全部成功，无1例术中中转开腹，除1例患者LC同时同孔行绝育手术后怀孕，其余无术中及术后并发症发生。结论 LC同时同孔完成多脏器手术实现了跨区域、多脏器同期手术，虽创伤范围增多，操作有一定的难度，仍具有微创外科的特点。一次完成多种手术，不明显增加患者的痛苦及费用，避免了患者在一种疾病治愈后再次住院手术治疗另一种疾病。
目的总结Millikan无张力疝修补术治疗腹股沟疝的经验。方法对笔者2008年1月至2010年1月期间完成的Millikan无张力疝修补术患者的临床资料进行总结、分析。结果本组 32例共35侧疝，按国内疝学组分型(2003年)，Ⅰ型2侧，Ⅱ型9侧，Ⅲ型21侧，Ⅳ型3侧。直疝6侧，斜疝29侧。其中行急诊疝修补术2例。术后发生尿潴留2例(6.25%),无切口感染、血肿、睾丸炎等并发症发生； 住院时间3~5 d，平均3.5 d。随访2~24个月，平均18个月，无复发及慢性疼痛者。结论Millikan手术是一种操作简便、安全、符合无张力疝修补原理的术式，适用于Ⅱ~Ⅳ型腹股沟疝的修补。
目的 探讨成人先天性胆总管囊肿的诊治方法和手术技巧。方法 对2001年5月至2011年5月期间我院手术治疗的成人先天性胆总管囊肿38例的临床资料进行回顾性分析。结果 全部病例均行B超和磁共振（MRCP）检查确诊，均行手术治疗。其中7例行急诊囊肿外引流术。行择期手术者中24例行囊肿切除、胆肠吻合术，其中3例合并肝叶切除术； 行内引流术4例； 仅行胆囊切除术3例。囊肿剥除采用点状钳夹、电凝及推剥囊肿黏膜外纤维血管束的办法，不出血，无副损伤。无手术死亡病例，术后恢复顺利。38例患者中术后获随访28例（73.68％），失访10例； 随访时间 3～120个月，平均74个月。24例行囊肿切除者症状消失20例，偶感上腹痛、抗炎治疗后症状可缓解1例，3例失访；11例行内或外引流术者术后近期均有不同程度的胆管炎症状，其中6例于术后2～10 年再手术，另5例失放，6例再手术者中2例术中发现癌变，分别于再手术后2个月和10个月死亡，余4例临床症状消失；3例仅行胆囊切除术者，2例失访，1例仍有反复发作的畏寒、发热及右上腹痛。结论 B超和MRCP检查有助于明确诊断； 囊肿全切除、肝管空肠Roux-en-Y 吻合术应作为胆总管囊肿的首选术式，囊肿外引流术仅在合并严重感染、全身情况差的患者采用； 手术技巧的改进可为手术提供安全保障。