【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除，1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。
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.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry in China.
Objective To enhance survival rate and treatment effect for advanced gallbladder cancer (GBC). MethodsEighty cases of advanced GBC were treated surgically from January 1990 to June 2001.Seventyone cases had obstructive jaundice, 15 had palpable abdominal mass. Extended radical cholecystectomy was performed in 39 cases of advanced GBC in which the tumor invaded the surrounding organs or tissues but without distant metastasis. ResultsFollowup showed that the survival period was between 8 and 37 months (average 18.1 months), 1， 2 and 3year survival rates were 43.6%， 20.5% and 5.1% respectively. Palliative operations were performed in other 41 advanced GBC cases with distant metastasis. All of the patients died within one year. Conclusion This result suggests that extended radical cholecystectomy is effective for advanced GBC.
目的 探讨三孔法腹腔镜胆囊阑尾联合切除术的临床价值。 方法 对64例胆囊良性病变合并急、慢性阑尾炎患者实施三孔法胆囊阑尾腹腔镜联合切除的临床资料进行分析。结果 64例均获成功，手术时间40~80 min，术后3~5 d出院，无并发症发生。结论 三孔法腹腔镜胆囊阑尾联合切除术具有创伤小、痛苦少、恢复快、住院时间短等优点，治疗胆囊阑尾良性疾病安全可靠，并可有效降低医疗费用。
目的 探讨瓷样胆囊腹腔镜手术治疗的技术和适应证。方法 对1995年1月至2009年1月期间我院收治的10例接受腹腔镜手术治疗的瓷样胆囊患者的临床资料进行回顾性分析。结果 10例瓷样胆囊均接受腹腔镜手术治疗，其中胆囊逆行切除6例, 胆囊大部切除2例，中转开腹2例（术中发生胆管损伤和发现胆囊癌各1例）。有1例术中冰冻检查证实为胆囊癌的患者经腹腔镜完整地切除胆囊。腹腔引流10例，仅1例发生漏胆，二次开腹手术探查见右肝管电灼伤，经放置T管引流，2周后痊愈。所有患者均痊愈出院, 无死亡病例。随访1.5~14年（平均11年），除1例胆囊癌患者于术后1.5年死亡，其余患者均恢复良好。结论 严格的适应证加上个体化的操作方法可以安全地完成腹腔镜瓷样胆囊切除术。
63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.
目的:探讨经脐入路行腹腔镜胆囊切除术的可行性。方法:对6例患者采用仅在脐部切开一个切口进行腹腔镜胆囊切除术。结果:6例患者手术均获成功,无中转常规腹腔镜手术或开腹手术。手术时间80～130min,无出血、胆管损伤等并发症发生。术后1d出院,术后1月门诊随访,患者恢复顺利,除脐部外,腹壁无手术瘢痕。结论:经脐入路腹腔镜胆囊切除术技术上是可行的,但难度较大,在开展手术初期应慎重选择病例。
Objective To explore the prevention and treatment of injury to brangches of the middle hepatic vein in laparoecopic cholecystectomy. Methods The clinical data of 27 hemorrhage cases of injury to brangches of the middle hepatic vein in laparoscopic cholecystectomy from January 2008 to January 2010 were analyzed retrospectively. Results All 27 hemorrhage cases were successfully stopped bleeding under laparoscopy by the way of packing hemostasis （n=17）, clamping hemostasis （n=6）, and suturing hemostasis （n=4）. In the 3 hemostasis methods, the operating time and amout of bleeding in the cases with packing hemostasis was the shortest and the least, respectively, which was （90.26±12.46） min and （240.32±80.15）ml, respectively, but the differences of the 3 methods were not statistical significance （P＞0.05）. Conclusions During laparoscopic cholecystectomy, gallbladder bed should be seperated in the correct plane to avoid injury to brangches of the middle hepatic vein. The most important to ensure surgery safety is applying the right surgical hemostasis method to stop bleeding quickly, and the open surgery will be the first choice in the right time when the difficult hemostasis occurs under laparoscopy.