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 study the suitable operation method of elderly patients with acute cholecystitis. Methods The clinical data of 149 elderly patients with acute cholecystitis were retrospectively analyzed. All patients were divided into two groups according to the operation: open cholecystectomy group (OC group, n=76) and laparoscopic cholecystectomy group (LC group, n=73). Some clinical data were compared in this paper such as operation time, blood loss, length of hospital stay, time of resumption of food, time of intestinal function recovery and complications. Results No marked difference was found between OC group and LC group about basic data except WBC count and examination of gallbladder by B ultrasound（P＞0.05）. But there were significant difference in operation time, blood loss, time of resumption of food, time of intestinal function recovery, length of hospital stay and complications between OC group and LC group （P＜0.01）. Conclusion Individualized treatment should be emphasized on elderly patients with acute cholecystitis. Selection of OC or LC to these patients should be based on the clinical condition and taken the safety as the first principle.
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.
Objective To explore the application effects of innovative health education on patients undergoing ambulatory laparoscopic cholecystectomy (LC). Methods A total of 139 patients undergoing ambulatory LC from November to December 2016 were selected as the control group, receiving the traditional health education; and other 141 patients undergoing ambulatory LC from February to March 2017 were selected as the observation group, receiving the innovative health education. The two groups were followed up and observed 1 day, 2, and 28 days after the discharge, and the incidence rates of adverse reactions such as postoperative pain, bleeding and incision infection were measured, and the disease knowledge mastery, self-care skills, medication compliance and satisfaction to nursing and hospital were evaluated. Results The total incidence rate of adverse reactions was 7.8% in the observation group and 25.2% in the control group (P<0.001). Medication compliance from high to low was 90, 46 and 5 cases in the observation group and 59, 64 and 16 cases in the control group (P<0.001). In the observation group, the scores of disease knowledge mastery, self-care cognition, nursing satisfaction and hospital satisfaction were 93.4±5.5, 91.4±4.5, 96.4±3.7 and 98.1±3.7, respectively, which were higher than those in the control group (83.8±8.7, 83.2±9.1, 91.5±9.2 and 94.8±7.3, respectively) with statistical significance (P<0.001). Conclusion Innovative health education has certain application effects on ambulatory LC, and it can significantly improve disease knowledge mastery and self-care cognition, and help to ensure the medical quality and safety during perioperative period, and improve the patients’ satisfaction.
Objective To evaluate the role of endoscopic retrograde cholangio-pancreatography(ERCP)in diagnosis of anomalous converge of the cystic duct and prevention of bile duct injuries during laparoscopic cholecystectomy(LC). Methods From July, 1992 to June, 1999, LCs were performed in 4 500 patients with gallbladder stone or cholecystitis at our center. Preoperative ERCPs were performed in 780 of all patients (14.50%). Anomalous junctions of the cystic duct with common hepatic duct were investigated and the length and caliber of these cystic duct were measured and compared with 100 control cases. Results An overall anomalous converges of the cystic duct were found in 125(16.03%) of the 780 patients undergoing ERCP. Of 780 patients undergoing LC, 35 cases were converted to open cholecystectomy(4.5%), and various complications occurred in 6 cases (0.77%), but no death and biliary duct injuries occurred. Conclusion Various types of anomalous junctions of the cystic duct could be diagnosed precisely by ERCP before LC and the preoperative examination of ERCP may be helpful in prevention of bile duct injuries and other biliary complications in the laparoscopic time.
Objective To observe the effects of epidural anaesthesia (EA) and general anaesthesia (GA) on the changes of plasma epinephrine (E) and norepinephrine (NE) during laparoscopic cholecystectomy (LC). Methods Thirty patients undergoing elective LC were randomly divided into GA group (n＝15) and EA group (n＝15). The concentrations of plasma NE and E were measured at the following phases: before anaesthesia, before introducing pneumoperitoneum, during pneumoperitoneum, and at the end of operation. Results In EA group, the concentrations of NE weren′t significantly different at each phase, the concentrations of E significantly increased before and during pneumoperitoneum (Ｐ＜0.05) and returned to the baseline at the end of operation (Ｐ＞0.05). In GA group, the concentrations of NE and E didn′t change significantly before pneumoperitoneum, but increased during pneumoperitoneum (Ｐ＜0.05) and E didn′t return to the baseline at the end of operation (Ｐ＜0.05). The E concentrations of EA group was higher than that of GA group before pneumoperitoneum, but the NE concentration of EA group was lower than that of GA group during pneumoperitoneum (Ｐ＜0.05). Conclusion Both groups has significant stress reaction, but the stress reaction of EA group is weaker than that of GA group during LC.
ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.
ObjectiveTo evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. MethodsA total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D1), moderate-dose dexmedetomidine hydrochloride injection group (group D2), and high-dose dexmedetomidine hydrochloride injection group (group D3). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T1), immediately after administration (T2), extubation after administration (T3), one minute after extubation (T4), and 5 minutes after extubation (T5). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. ResultsCompared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1 (P<0.05), while the correspondent difference was not statistically significant in group D2 and D3 (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1 (P>0.05). However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1 (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3. ConclusionIntravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
The aim of this study was to evaluate ultrasonic findings as predictor of potential operative difficulties and complications during laparoscopic cholecystectomy (LC). From Auguest 1995 to December 1996 a total of 328 patients with symptomatic cholelithiasis (92 males, 236 females, mean age 45±17 years) were examined by ultrasonography (US) 1 to 3 days before LC. The US examination assessed six paramenters: (GB) volume of gallbladder thichness of GB wal position of neck of GB, stone mobility, maximal size of stone, and GB adhesions. On the basis of these US findings, a predictive judgment of technical difficulties was expressed as easy, difficult, and very difficult. Two hundred and twenty five patients presented with uncomplicated symptomatic cholelithiasis, and 103 had acute cholecystitis. The operation was predicted to be easy in 38% of cases, difficult in 48% and very difficult in 14% with a good correlation with the surgeon’s intraoperative judgment (Ｐ＜0.01). A significant association was found between stone mobility (Ｐ＜0.01), presence of adhesions (Ｐ＜0.01) and the difficulty of the procedure. Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties during LC.