目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性结石嵌顿性胆囊炎的可行性。方法:总结分析2007年10月至2009年6月36例急性结石嵌顿性胆囊炎行腹腔镜胆囊切除术的经验体会,包括手术适应证及手术技巧等。结果:35例(972％)成功完成腹腔镜胆囊切除术,1例(28％)中转开腹,无胆管、肠管损伤,无术后出血及围手术期(术后30天)死亡等并发症,均获治愈。术后随访4月～23月无手术并发症。结论:在术者熟练的操作技巧,合理选择中转开腹时机的前提下,急性结石嵌顿性胆囊炎行腹腔镜胆囊切除术安全、可行。
ObjectiveTo investigate the occurrence and treatment of postoperative complications after laparoscopic laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) or pancreaticoduodenectomy (LPD). MethodThe clinical data of 130 patients undergoing LPD from October 2010 to December 2015 in West China Hospital of Sichuan University were analyzed retrospectively. ResultsOf 130 patients, postoperative complications occurred in 55 cases, including 24 cases of pancreatic fistula, 14 cases of gastric emptying disorder, 3 cases of anastomotic bleeding, 6 cases of peritoneal infection, 1 case of bile leakage, 1 case of venous thrombosis, 1 case of chylous leakage, 5 cases of peritoneal effusion, without the occurrence of stress ulcer and incision complications. There were significant difference in the incidence of pancreatic fistula (P=0.025), gastric emptying disorder (P=0.034), anastomotic bleeding (P=0.020), and peritoneal infection (P=0.016) among prophase group, metaphase group, and the later stage group. ConclusionsThe most common complication after LPD is pancreatic fistula. With the improvement of surgical techniques and procedures, incidences of some postoperative complications decreases gradually.
Objective To formulate an evidence-based treatment plan for a patient with suspected pyogenic liver abscess. Methods Based on the clinical questions raised by a patient with suspected pyogenic liver abscess, we searched The Cochrane Library (Issue 4, 2007), MEDLINE (1996 to January 2008), ACP Journal Club (1991 to January 2008), and Chinese Journal Full-text Database (1994 to January 2008) for systematic reviews, randomized controlled trials (RCTs) and case-control studies. The quality of the included studies was assessed. Results We did not find any systematic reviews or large-scale RCTs involving a comparison between laparoscopic drainage and surgical drainage in the treatment of pyogenic liver abscess. Four clinical retrospective studies closely related to our questions were found and assessed. These studies concluded that laparoscopic drainage for liver abscesses was a safe alternative for patients requiring surgical drainage. Based on the current evidence, as well as our clinical expertise and the patient’s values, laparoscopic drainage was not used for this patient and surgical drainage was applied. The patient was recovered and discharged. Conclusion Current evidence showed that laparoscopic drainage might be effective and safe for liver abscesses but high-quality large-scale randomized controlled trials are still required.
ObjectiveTo explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.MethodsThe clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.ResultsTwo cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.