目的 了解单纯胆囊切除术患者围手术期抗菌药物的使用情况及合理性，促进临床合理用药。 方法 对昆明医学院第二附属医院2004年7～9月期间出院的661例单纯胆囊切除术患者应用抗菌药物的合理性进行回顾性分析。结果 胆囊切除患者抗菌药物应用共涉及9大类39个品种，使用率为100%。预防用药380例（57.49%），其中单用38例(10.00%)，平均用药6.55 d，平均住院时间10.79 d； 两联281例(73.95%)，平均用药6.49 d，平均住院时间12.30 d； 三联57例(15.00%)，平均用药6.52 d，平均住院时间11.75 d； 四联4例(1.05%)，平均用药6.75 d，平均住院时间9.00 d。感染治疗281例(42.51%)，其中单用10例(3.56%)，平均用药9.60 d，平均住院时间15.10 d； 两联206例(73.31%)，平均用药11.25 d，平均住院时间15.79 d； 三联56例(19.93%)，平均用药15.23 d，平均住院时间15.23 d； 四联9例(3.20%)，平均用药13.00 d，平均住院时间21.78 d。结论 单纯胆囊切除术患者抗菌药物使用存在一些不合理现象，应按围手术期给药方案进行。加强抗菌药物使用的管理和监督，不仅减少耐药菌株及不良反应的产生，而且对降低医药费用具有积极的意义。
目的 探讨如何预防腹腔镜胆囊切除术(LC)中的胆管损伤。方法 回顾性分析2006年1月至2008年12月期间在我院行LC的657例患者的临床资料，总结预防胆管损伤的经验。结果 651例患者完成LC，中转开腹手术6例(0.91%)，其中1例(0.15%)因Calot三角致密粘连误伤胆总管。术后胆囊床毛细胆管渗漏2例，每日经腹腔引流管引出胆汁性液体20～50 ml，7～10 d 治愈出院。术后578例（包括中转开腹6例）患者获随访,随访率为87.98%，随访时间为2～24个月, 平均14个月。23例患者剑突下隐痛, 4个月内均自行消失，其余患者均未发现并发症。结论 严格掌握手术适应证、正确仔细地处理Calot三角和适时中转开腹是预防LC术中胆管损伤的关键。
ObjectiveTo explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. MethodsThe patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. ResultsA total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). ConclusionAccording to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.
BY the method of clinical epidemiology and evaluation ,the comprehensive evaluation of laparoscopic cholecystectomy (LC) including safety,effect and satisfaction of patients has been given in this paper. The comparative study was done between the LC and the traditional opened cholocystectomy (OC). The conclusion suggests that this therapy would have evry important significance to improve the efficiency of utility of medical resources and the benefit of health care and the quality of life of the patient. Some information had been furnished in this study to extend laparoscopic operation appropriately in our country.
ObjectiveTo investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. MethodsThe eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy (observation group) or laparoscopic cholecystectomy (control group) minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and follow-up results were compared between the two groups. ResultsA total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0% (68/68) and 98.8% (79/80), respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was (49.6±5.2) minutes for the observation group and (50.5±6.2) minutes for the control group, and bleeding volume was (9.5±1.4) mL for the observation group and (50.2±8.1) mL for the control group; the difference in bleeding volume was significant between the two groups (P<0.05). The difference in enterokinesia recovery time[(33.9±2.2) and (34.4±2.6) minutes] or hospital stay[(3.4±1.0) and (3.6±1.2) days] between the observation group and the control group was not significant (both P >0.05). The post-operative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients (1/37) had stone recurrence after 3-year follow-up. ConclusionBoth laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient. However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.
目的探讨低压辅助悬吊式腹腔镜在合并心血管疾病患者行腹腔镜胆囊切除术（LC）中的应用价值和安全性。 方法回顾性分析2007年1月至2010年10月期间，通渭县中医院普外科以及甘肃省人民医院普外科收治的132例合并心血管疾病的急、慢性胆囊炎或胆囊结石患者的临床资料。 结果132例患者均进行了低压辅助悬吊式LC，手术均顺利完成，成功率为100%，无中转开腹，患者术中、术后生命体征正常。 结论低压辅助悬吊式腹腔镜技术在合并心血管疾病患者中是安全、可行的。
ObjectiveTo evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. MethodsA total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D1), moderate-dose dexmedetomidine hydrochloride injection group (group D2), and high-dose dexmedetomidine hydrochloride injection group (group D3). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T1), immediately after administration (T2), extubation after administration (T3), one minute after extubation (T4), and 5 minutes after extubation (T5). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. ResultsCompared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1 (P<0.05), while the correspondent difference was not statistically significant in group D2 and D3 (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1 (P>0.05). However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1 (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3. ConclusionIntravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
目的探讨经腹正中线入路2孔法腹腔镜胆囊切除术的可行性。 方法对笔者所在医院2009年5月至2013年3月期间收治的220例胆囊结石、胆囊炎患者行经腹正中线入路2孔法腹腔镜胆囊切除术，观察其手术时间、术后疼痛、并发症发生情况及恢复时间。 结果220例中成功施行经腹正中线入路2孔法腹腔镜胆囊切除术215例，成功率为97.73%，手术时间30～110 min，平均45 min。另5例因炎症严重、操作困难而改为3孔法完成腹腔镜胆囊切除术，并行腹腔引流。本组患者无中转开腹者，术后均未用镇痛剂，也无并发症发生；术后住院时间3～5 d，平均4 d。 结论经腹正中线入路2孔法腹腔镜胆囊切除术，具有切口更少、创伤更小、疼痛轻、康复快、美容效果更好、不增加设备投入等优点。
目的探讨嵌顿性胆囊结石行腹腔镜胆囊切除术(LC)的经验。方法回顾性分析我院1998年1月至2004年12月期间用LC治疗嵌顿性胆囊结石365例的临床资料。结果358例成功施行LC,7例中转开腹,2例术后发生胆瘘,无胃肠道、胆管损伤等并发症,无死亡病例,全部患者均痊愈出院。结论随着腹腔镜技术日臻完善，嵌顿性胆囊结石选择LC，一次性切除病灶，术后恢复快，并发症少。