目的 探讨内镜逆行胰胆管造影(ERCP)检查及内镜治疗在腹腔镜胆囊切除(LC)术前、术后的应用价值。 方法 对61例拟行LC的患者术前或术后行ERCP检查，发现异常再行内镜治疗。结果 LC术前行ERCP者42例中39例显影，其中37例伴有其他胆管疾病，占94.9%。术后行ERCP者19例均显影，总的插管成功率为95.1%。LC术前或术后42例行EST治疗，4例行EPBD，2例行ERBD，15例行ENBD，另4例在行ERCP检查后改开腹手术，取石成功率为92.9%。结论 诊治性ERCP在LC前、后的应用，对进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。
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 结合腹腔镜手术的特点，设计出部分顺逆结合法腹腔镜胆囊切除术(LC)，总结该法的应用体会。方法 介绍部分顺逆结合法LC的方法。在1 250例LC中有255例采用部分顺逆结合法切除胆囊，其中慢性胆囊炎146例，急性、亚急性胆囊炎65例，慢性萎缩性胆囊炎44例。结果 所有患者均获痊愈。术中发现胆囊三角区细小副肝管4例，胆汁渗漏3例，均予妥善处理，无严重并发症发生。结论 该法吸取了开腹顺逆结合法胆囊切除术的优点，又符合腹腔镜手术的特点，适用于胆囊三角解剖结构不清者的手术。该法对发现解剖变异及避免胆管损伤有一定的作用。
Objective To summarize the treatment experience for concomitant diseases of other abdominal organs in laparoscopic cholecystectomy （LC）. Methods The clinical data of 176 patients with LC and concomitant diseases of other abdominal organs were analyzed retrospectively， including preoperatively diagnosed cases （such as 53 with liver cyst， 15 with choledocholithiasis， 7 with chronic appendicitis， 5 with inguinal hernia， 4 with renal cyst， and 6 with ovarian cyst） and intraoperatively diagnosed cases （such as 72 with abdominal cavity adhesion， 4 with internal fistula between gallbladder and digestive tract， 3 with Mirizzi syndrome， and 7 with unsuspected gallbladder carcinoma）. Results All the operation were successfully completed in 176 patients without severe complications， including 53 cases treated with LC plus fenestration of hepatic cyst， 15 with choledocholithotomy， 7 with appendectomy， 5 with tension free hernia repair， 4 with renal cyst fenestration， 6 with oophorocystectomy， 72 with adhesiolysis， 3 with fistula resection plus intestine neoplasty， 2 with intraoperative cholangiography plus choledocholithotomy， 5 with LC plus gallbladder bed complete burning， and 4 cases treated with conversion to open surgery （1 with intestinal fistula repair， 1 with choledocholithotomy， and 2 with radical resection for gallbladder carcinoma）. Conclusions It is safe and effective to treat gallbladder diseases complicated with other concomitant diseases simultaneously with laparoscopic operation， if the principles of surgical operation are followed and the indications and applicable conditions are strictly followed. And conversion to open surgery is necessary.
Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007， 113 patients including chronic gallstone cholecystitis （n=55）, inactive cholecystolithiasis （n=46） and gallbladder polyps （n=12） were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation， 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC， 3 months and 6 months after LC were (5±2) mm, (8±2) mm and (6±2) mm respectively. And in chronic gallstone cholecystitis patients they were (5±2) mm, (9±2) mm and (6±2) mm respectively， in inactive gallstone cholelithiasis patients they were (5±2) mm, (8±2) mm and (6±2) mm respectively， and in gallbladder polyps ones they were (5±2) mm, (7±2) mm and (5±2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.
目的:探讨腹腔镜胆囊切除术的适应症及适用人群。方法:回顾分析我院1998～2007年2168例腹腔镜胆囊切除术的疾病种类及年龄、性别分布。结果:胆结石伴慢性胆囊炎1994例占91.97%,胆囊息肉106例,占4.89%,急性胆囊炎伴胆囊结石68例,占3.14%;男性575例,占26.52%,女性1693例,占73.48%;年龄lt;20岁21例,占0.97%,21~55岁1570例,占72.70%,56~65岁363例,占16.74%,年龄gt;66岁208例,占9.59%,最小年龄15岁,最大年龄84岁。手术中转59例,占2.72%。结论:慢性胆囊炎、胆囊结石、胆囊良性隆起样病变是腹腔镜胆囊切除术的主要适应症;腹腔镜胆囊切除术适用于各年龄段的患者。
目的探讨腹腔镜与开腹胆囊切除术对患者肝功能及免疫功能的影响。 方法根据手术方式将84例胆囊良性病变患者分为腹腔镜胆囊切除术组（LC组，50例）及开腹胆囊切除术组（OC组，34例），比较2组患者手术前后肝功能及免疫功能指标的变化。 结果2组患者肝功能在手术前后不同时间点的差异均无统计学意义（P＞0.05）；LC组患者术后免疫功能各指标与术前比较无明显变化（P＞0.05），OC组CD3+、CD4+及CD4+/CD8+在术后1 d及3 d均较术前明显降低（P＜0.05），术后7 d恢复至术前水平（P＞0.05）。 结论LC术可引起患者术后肝功能短暂异常，但对免疫功能无明显影响，可作为胆囊切除的首选术式。
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.