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POSTOPERATIVE RETAINED BILIARY STONES TREATED CHOLEDOCHFIBERSCOPY(REPORT OF 108 CASES)

目的 總結纖維膽道鏡對膽道術后殘留結石的治療作用。方法 應用纖維膽道鏡治療膽道術后殘留結石108例。結果取石成功率96.9%，結石取凈率80.5%。結論 纖維膽道鏡對解決膽道術后殘留結石有其重要作用，并可降低再手術率。

腹腔鏡膽囊切除術少見并發癥(附2例報告)

電視腹腔鏡膽囊切除術282例體會

Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases)

Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.

Further Exploring and Discussing Clinical Value of Laparoscopic Appendectomy

ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.

THE MULTI-ORGANS OPERATIONS AT THE SAME TIME AND BY THE SAME PORES (REPORT OF 51 CASES)

目的 探討腹腔鏡膽囊切除術(LC)同時同孔完成多臟器手術可能性及手術方法。方法 總結1993年3月至1999年4月完成LC 2 170例，其中LC同時同孔完成多臟器手術51例。結果 該51例手術全部成功，無1例術中中轉開腹，除1例患者LC同時同孔行絕育手術后懷孕，其余無術中及術后并發癥發生。結論 LC同時同孔完成多臟器手術實現了跨區域、多臟器同期手術，雖創傷范圍增多，操作有一定的難度，仍具有微創外科的特點。一次完成多種手術，不明顯增加患者的痛苦及費用，避免了患者在一種疾病治愈后再次住院手術治療另一種疾病。

Experience of Millikan TensionFree Herniorrhaphy in Treatment for Inguinal Hernia (Report of 32 Cases)

目的總結Millikan無張力疝修補術治療腹股溝疝的經驗。方法對筆者2008年1月至2010年1月期間完成的Millikan無張力疝修補術患者的臨床資料進行總結、分析。結果本組 32例共35側疝，按國內疝學組分型(2003年)，Ⅰ型2側，Ⅱ型9側，Ⅲ型21側，Ⅳ型3側。直疝6側，斜疝29側。其中行急診疝修補術2例。術后發生尿潴留2例(6.25%),無切口感染、血腫、睪丸炎等并發癥發生； 住院時間3~5 d，平均3.5 d。隨訪2~24個月，平均18個月，無復發及慢性疼痛者。結論Millikan手術是一種操作簡便、安全、符合無張力疝修補原理的術式，適用于Ⅱ~Ⅳ型腹股溝疝的修補。

Analysis on Diagnosis and Treatment of 38 Adult Patients with Congenital Choledochal Cyst

目的　探討成人先天性膽總管囊腫的診治方法和手術技巧。方法　對2001年5月至2011年5月期間我院手術治療的成人先天性膽總管囊腫38例的臨床資料進行回顧性分析。結果　全部病例均行B超和磁共振（MRCP）檢查確診，均行手術治療。其中7例行急診囊腫外引流術。行擇期手術者中24例行囊腫切除、膽腸吻合術，其中3例合并肝葉切除術； 行內引流術4例； 僅行膽囊切除術3例。囊腫剝除采用點狀鉗夾、電凝及推剝囊腫黏膜外纖維血管束的辦法，不出血，無副損傷。無手術死亡病例，術后恢復順利。38例患者中術后獲隨訪28例（73.68％），失訪10例； 隨訪時間 3～120個月，平均74個月。24例行囊腫切除者癥狀消失20例，偶感上腹痛、抗炎治療后癥狀可緩解1例，3例失訪；11例行內或外引流術者術后近期均有不同程度的膽管炎癥狀，其中6例于術后2～10 年再手術，另5例失放，6例再手術者中2例術中發現癌變，分別于再手術后2個月和10個月死亡，余4例臨床癥狀消失；3例僅行膽囊切除術者，2例失訪，1例仍有反復發作的畏寒、發熱及右上腹痛。結論　B超和MRCP檢查有助于明確診斷； 囊腫全切除、肝管空腸Roux-en-Y 吻合術應作為膽總管囊腫的首選術式，囊腫外引流術僅在合并嚴重感染、全身情況差的患者采用； 手術技巧的改進可為手術提供安全保障。