目的 了解单纯胆囊切除术围手术期应用预防性抗生素的作用。方法 对我院普外一科1998年1月至1999年12月2年间所施行的642例择期单纯胆囊切除术围手术期抗生素的使用、细菌培养结果和切口感染情况进行回顾性分析。结果 642例根据其抗生素应用情况分为未用抗生素组(n＝220)、术前30分钟一次性给药组(n＝200)和术后3天持续用药组(n＝222) 3组，3组患者之性别、年龄构成情况、全身状况及发生术后切口感染情况间的差异均无显著性意义(Ｐ＞0.05)； 对642例中随机选择52例行术中胆囊胆汁培养，结果47例无细菌生长。结论 对单纯胆囊切除术患者术前无感染前提下，不用或仅术前30分钟一次性使用抗生素是安全可行的，这对缩短患者住院日，减少其医疗费用具有积极的意义。
目的 探讨急诊条件下胆囊结石合并胃恶性肿瘤的诊断与治疗。方法 回顾性分析6例因胆囊结石行胆囊切除、术中意外发现胃恶性肿瘤患者的临床资料及治疗过程。结果 6例患者中5例发现胃癌，1例发现原发性胃恶性淋巴瘤。5例施行胃癌根治术，1例施行全胃切除术，无术后并发症，术后定期化疗，随访6～43个月，至术后随访截止日（2008年12月）均存活。结论 老年胆囊结石患者应注意合并胃恶性肿瘤的可能，胆囊切除术中仔细探查胃及周围器官极为重要，同时施行根治性切除是最佳选择。
From the March of 1993 to the May of 1994, we had performed laparoscopic cholecystectomy (LC) for 200 patients of the age ranged 19-77 years. In these cases, 12 had previous abdominal surgery; 3 cases had hepatic cysts; 11 cases had stones in the neck of gall bladders. We had successfully performed LC for 190 cases (95%). But we also had some unsuccesful experiences, including accidental injury to the stomach or duodenum, and bleeding from cystic arteris of the gallbladder. Operation (LC) was abandoned in one patient because of severe cardiac arrhyshmia developed during operation, and billiary tract injury was found postoperatively in three patients with no postoperative death. The operative indications and technical problems of LC are discussed in detail and measures in avoiding injury to billiary or GI tract from LC are introduced.
目的探讨腹腔镜联合胆道镜治疗胆囊及胆总管结石的临床疗效。 方法回顾性分析2010年1月至2013年1月期间收治于笔者所在科室的96例胆囊及胆总管结石患者的临床资料，根据手术方式分为开腹组、腹腔镜联合胆道镜＋T管引流术组和腹腔镜联合胆道镜＋放置鼻胆管一期缝合组3组。对3组患者的手术时间、术中出血量、肛门排气时间、住院时间、残石率、复发率、并发症发生率、手术有效率及术后淀粉酶和肝功能指标水平进行对比分析。 结果微创手术组与开腹组比较，患者的出血量、肛门排气时间、住院时间、残石率、复发率及并发症发生率均减少、缩短或降低，同时手术的有效率提高（P＜0.05）；腹腔镜联合胆道镜＋放置鼻胆管一期缝合组术后淀粉酶和肝功能指标的水平较其他2组明显降低（P＜0.05）。 结论微创手术创伤小，残石率及复发率低，并发症少，患者术后恢复快，是一种安全有效的治疗方式，值得临床推广应用。
目的 探讨减少和预防腹腔镜胆囊切除术(LC)并发症的措施。方法 对我院2004年1月至2008年12月期间1 050例LC患者的临床资料进行回顾性分析。结果 手术时间11～86 min，平均32 min; 术中出血2～106 ml，平均21 ml。18例(1.7%)患者中转开腹，其中7例为术中无法完成胆囊三角解剖，4例胆管损伤，2例Mirizzi综合征，1例胆肠内瘘和4例发生无法控制性出血。6例患者术后出现胆漏，其中胆囊床迷走胆管漏2例，肝外胆管漏4例; 8例患者术后继发胆总管结石，2例术后胆囊管残石; 51例术后诊断为胆囊切除术后综合征，其中胆总管下端狭窄24例，残余胆囊管过长（≥1 cm）或残余胆囊结石16例，11例无明显原因。术后1例患者因肺栓塞死亡，2例胆心综合征患者未改善转心内科继续治疗。结论 掌握好LC手术适应证、成熟的LC操作技巧、术中仔细处理胆囊三角和胆囊床、选择性安置腹腔引流管、适时中转开腹是减少术中、术后并发症发生的关键。
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.
目的:探讨腹腔镜胆囊切除术对胆囊结石合并肝硬化的围手术期影响及技术特点。方法:回顾分析80例胆囊结石合并肝硬化患者行腹腔镜胆囊切除术(LC)、开腹胆囊切除术(OC)前后肝功能、凝血功能及术中出血量、手术时间、术后住院时间、术后禁食时间等临床资料并比较两组间差异。结果:全组无死亡、术后肝功能衰竭、胆道损伤、胆漏等严重并发症病例。手术及麻醉对肝功能、凝血功能的影响在LC、OC两组间比较差异无显著意义(Pgt;0.05)。LC组在手术时间、术中出血量、术后禁食时间、术后住院时间等指标方面优于OC组,两组间差异有显著意义(Plt;0.05)。结论:与OC比较,胆囊结石合并肝硬化行LC是安全的,并且有着微创、术后恢复快等优势,关键是掌握手术的技术特点、注重Child-push分级及围手术期的处理。
ObjectiveTo explore the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and LC combined with laparoscopiccommom bile duct exploration and primary sture (LBDEPS) in the treatment of cholecystolithiasis complicated with choledocholithiasis in the elderly (age more than 75 years old).MethodsThe elderly patients with cholecystolithiasis complicated with choledocholithiasis in the Tianyou Hospital Affiliated to Wuhan University of Science and Technology from March 1, 2018 to June 30, 2019 were retrospectively collected, then were designed into an ERCP combined with LC therapy group (ERCP+LC group) and a LC combined with LBDEPS therapy group (LC+LBDEPS group) according to the therapy methods. The operative indexes (total operation time, general anesthesia time, intraoperative bleeding volume, LC conversion to laparotomy) and postoperative indexes (conversion to ICU, use time of ventilator in the ICU, drainage tube indwelling time, ventilation time, time of getting out of bed, postoperative hospitalization time, total hospitalization time, total hospitalization costs, stone clearance rate, and complications) were compared between the two groups.ResultsIn this study, 67 patients were collected, including 35 patients in the ERCP+LC group and 32 patients in the LC+LBDEPS group. There were no significant differences between the two groups in the terms of baseline data, such as the patients’ gender, age, preoperative symptoms, preoperative complications, number of choledocholithiasis, maximum diameter of choledocholithiasis, and diameter of common bile duct, etc. (P>0.05). Compared with the LC+LBDEPS group, the ERCP+LC group had more advantages in the terms of the total operation time, general anesthesia time, intraoperative bleeding, rate of LC conversion to laparotomy, time of ventilator use in the ICU, postoperative ventilation time, postoperative time of getting out of bed, and drainage tube indwelling time (P<0.05). The others indexes had no significant differences between the two groups (P>0.05).ConclusionsAccording to the results of this study, therapeutic efficacy of ERCP+LC and LC+LBDEPS in treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis have no significant differences, but ERCP+LC therapy has more advantages than LC+LBDEPS in total operation time, general anesthesia time, intraoperative bleeding, LC conversion to laparotomy, postoperative recovery and so on, and appropriate operation mode might be selected according to specific situation of patients and local medical conditions.