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find Keyword "胆囊切除" 213 results
  • 二孔法腹腔镜胆囊切除术的临床应用体会

    【摘要】 目的 探讨二孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。 方法 2006年6月-2010年3月,采用二孔法LC治疗450例结石性胆囊炎及胆囊息肉病变患者。其中男82例,女368例;年龄15~78岁,中位年龄52岁。反复右上腹痛及隐痛不适3个月~20年。所有患者均于术前经多次B超检查确诊,包括胆囊结石419例(急性炎症期25例)、胆囊息肉样病变31例;胆总管无扩张。 结果 450例手术均成功。无术后出血、胆漏、胆管损伤、胆管残余结石、穿刺孔感染等并发症发生。术后第1天开始进食,住院5 d拆线,均康复出院。随访时间为1~45个月,末次随访时患者均恢复正常饮食,无腹痛、发热及黄疸等症状,生活质量良好。 结论 二孔法LC治疗结石性胆囊炎及胆囊息肉病变患者安全可行。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • Investigation of Antibacterial Drug Utilization in 661 Patients of Cholecystectomy

    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。

    Release date:2016-09-08 11:49 Export PDF Favorites Scan
  • Prevention of Biliary Duct Injury During Laparoscopic Cholecystectomy

    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。

    Release date:2016-09-08 10:54 Export PDF Favorites Scan
  • Operative Technique and Curative Effect Analysis of Minor-Incision Cholecystectomy

      Objective To discuss the operative technique and curative effect of minor-incision cholecystectomy.   Methods The clinical data of 672 patients with application of mini-cholecystectomy from June 2001 to June 2009 were analyzed. Perioperative management and operative technique were emphasized.   Results Six hundred and fifty-two cases (97.0%) were cured with mini-cholecystectomy and 20 cases (3.0%) with incision lengthened. Operation time was (40.0±10.0) min. One case with hemorrhoea during operation was cured by interventional embolotherapy. Bile duct injury was found in 1 case during operation, and adopted suture with T tube. There were no infection of incisional wound or death in this study.   Conclusion On the basis of skillful conventional cholecystectomy, by controlling indication and improving operative technique, it is an economical and safe way to perform minor-incision cholecystectomy.

    Release date:2016-09-08 10:52 Export PDF Favorites Scan
  • 腹腔镜胆囊切除术中意外胆囊癌的外科治疗

    【摘要】 目的 探讨腹腔镜胆囊切除术(LC)中意外胆囊癌(UGC)的外科治疗。 方法 回顾性分析2002年1月-2008年12月行LC中16例意外UGC的临床资料。 结果 16例UGC中,术中诊断10例,术后诊断6例;pT1 期5例,pT2期9例,pT3期2例。患者1、3和5年存活率分别为80.0%、73.3%、60.0%。pT1期患者5年存活率为100.0%,pT2期患者5年存活率为50.0%,pT3期患者5年存活率为0.0%。 结论 UGC患者的存活与肿瘤分期相关。pT1期UGC行LC即可。术中疑诊UGC需及时行冰冻病理检查,对于确诊pT1期以外的UGC应尽早开腹行UGC根治术,并采用必要措施防止肿瘤种植和转移。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
  • Correlation between cholecystectomy or gallbladder disease and bile reflux gastritis

    ObjectiveTo study the relationship among cholecystectomy/gallbladder disease and bile reflux gastritis.MethodsA retrospective collection of 123 patients with bile reflux gastritis who were diagnosed as outpatients and hospitalized from January 2014 to February 2019 in Shengjing Hospital Affiliated to China Medical University, and 221 patients with non-biliary reflux gastritis at the same period were collected. According to the gallbladder status, the patients were divided into three groups: gallbladder disease, cholecystectomy, and gallbladder disease-free group. The relationship between gallbladder status and bile reflux gastritis was analyzed.ResultsAmong 123 patients with bile reflux gastritis, there were 22 cases (17.89%) with cholecystectomy and 26 cases (21.14%) with gallbladder disease; 221 cases of non-biliary reflux gastritis with cholecystectomy in 7 cases (3.17%) and gallbladder disease in 30 cases (13.57%). Univariate analysis showed that the gallbladder status was different between the bile reflux gastritis group and the non-biliary reflux gastritis group (χ2=21.089, P<0.001). The study showed that the gallbladder status was related to the occurrence of bile reflux gastritis. In contrast, patients with cholecystectomy and gallbladder disease had a higher risk of occurrence than those with no gallbladder disease (OR>1, P<0.012 5). Independent risk factors were considered by logistic multivariate regression analysis, including cholecystectomy, gallbladder disease, and age (P<0.05).ConclusionsThere is a correlation between cholecystectomy/gallbladder disease and bile reflux gastritis. Cholecystectomy and gallbladder disease may be the independent risk factors for bile reflux gastritis.

    Release date:2019-09-26 10:54 Export PDF Favorites Scan
  • Nursing Observation and Intervention of Extrahepatic Bile Duct Stones with Gallstones Treated with Electronic Duodenoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy

    ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.

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  • Optimal surgical timing for sequential laparoscopic cholecystectomy following percutaneous cholecystostomy for acute cholecystitis

    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.

    Release date:2024-02-28 02:42 Export PDF Favorites Scan
  • COMPREHENSIVE EVALUATION OF EFFECTIVENESS OF LAPAROSCOPIC CHOLECYSTECTOMY

    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.

    Release date:2016-08-29 03:44 Export PDF Favorites Scan
  • Clinical Efficacy of Laparoscopic Minimally-invasive Surgery for Gallbladder Stone

    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.

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