ObjectiveTo evaluate the security and feasibility of transumbilical laparoendoscopic single-site cholecystectomy (TULESC) with conventional laparoscopic instruments.
MethodsThe clinical data of 62 adult patients undergoing TULESC between October 2011 and June 2013 were analyzed retrospectively. There were 13 males and 49 females aged between 22 and 70 years old averaging 40±15. Forty-nine patients suffered from chronic cholecystitis with cholelithiasis, 10 from asymptomatic cholelithiasis and 3 from cholecystic polyposis. A single arc incision was cut on the edge of the umbilicus, and two 10 mm Trocars and one 5 mm Trocar were placed by puncture. Cholecystectomy was performed with conventional laparoscopic instruments and equipment.
ResultsAll the 62 patients underwent TULESC successfully without severe complications such as bile leakage or biliary injury. The operation time was 20-70 minutes with the average of (40±15) minutes; The blood loss was 5-40 mL with the average of (15±10) mL. All the patients were discharged from the hospital within 3 to 7 days after surgery, averaging 4.0±1.0. During the 1 to 12-month follow-up (averaging 3 months), there was no obviously visible scars on the abdominal wall and the aesthetic effect was significant.
ConclusionTULESC with conventional laparoscopic instruments and equipment is safe, feasible and cosmetic.
ObjectiveTo investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. MethodsFifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium-enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steadystate precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. ResultsThe bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.ConclusionMR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.
Objective To investigate the effect of cholecystectomy on the induction of large intestine cancer and its mechanism. Methods After cholecystectomy, the large intestine neoplasm in mice was induced with dimethylhydrazine(DMH).The histogenesis and growth pattern of large intestine cancer were observed.The Sphase fraction (SPF) of epithelium cells in large intestine mucosa was determined using flow cytometry. Before and after operation, the feces of mice were collected to determine the cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA) and lithocholic acid (LCA) concentration by highperformance liquid chromatography. Results The average number of large intestine neoplasms per mouse,percentage of large intestine adenomas in examined mice and SPF of experimental group were significantly higher than those of control group (P＜0.05). The fecal LCA concentration in postcholecystectomy was significantly higher than that in precholecystectomy and in sham operation group (P=0.00). Conclusion The large intestine neoplasm of mice induced by DMH is increased and the proliferation of epithelium cell in large intestine mucosa is increased after cholecystectomy. This suggests that cholecystectomy has promoting effect on induction of large intestine neoplasm in mice. The gut may deal with the increased secondary bile acid(LCA) concentration postcholecystectomy.
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.
This study was designed to determine the effects of different anaesthesia on the postoperative gastrointestinal motility after cholecystectomy. Postoperative gastrointestinal motility were recorded continuously by means of gastrointestinal manometry in 20 patients subject to cholecystectomy (general anaesthesia 10, epidural anaesthesia 10). Normal migrating motor complex (MMC) was abolished during the early postoperative period in all patients. The time of reappearance of intestinal MMC varied from 0.5 to 2 hours . Gastric MMC recurred 5.5 to 14 hours postoperatively and the normal MMC completely recovered 22 to 43 hours after the operations. Ingestion of food changed the MMC into a fed pattern during the early postoperative period. There was no difference between the general anaesthesia group and epidural anaesthesia group in terms of gastrointestinal motility. The results indicate that postoperative gastrointestinal motility recovers faster than that was thought conventionally. Cholecystectomy under general anaesthesia or under epidural anaesthesia makes no difference in postoperative gastrointestinal motility.
Injury of the gallbladder beds on the liver during laparoscopic cholecystectomy of 178 cases for the last year waas analysed. Reoperations in 6 cases with one death due to major postoperative complications. These injuries could be classified into 3 degrees according to extent of liver parenchyma denuded in the bed . Degree Ⅰ, no liver was denuded in the bed with the fibromembranous lining intact (49 cases);Degree Ⅱ, liver denuded area was less than one half of the bed (90 cases);Degree Ⅲ, liver denuded area was greater than half of the bed ( 39 cases). There was close relationship between grade of the bed injury and the postoperative complication. Leaving the lining intact of the bed was most important during the lapatoscopic cholecystectomy in order to prevent complication from the bed. The method was discussed. Drainage of the subhapatic space was suggested when liver bed is denuded.
【Abstract】ObjectiveTo evaluate the injury of common bile duct in immediate removal of the ligation in cholecystectomy. MethodsEighteen healthy Japanese rabbits were selected and divided into three groups randomly: A group treated with simple cholecystectomy, B group with cholecystectomy plus common bile duct crossligation and C group with cholecystectomy plus hepatic bile duct conjunction “Y”type ligation. The ligation was removed after 5 min in B and C groups. The levels of serum transaminase and bilirubin and pathological changes of bile duct and liver in each group were observed respectively. ResultsThere were no statistic difference in the levels of GPT, GOT, total bilirubin (TB), direct bilirubin (DB) and DB/TB on 12 hours before operation and the 1st and 7th day after operation between A and ligation groups (Pgt;0.05). But there were statistic difference in the those indexes and pathological changes of bile duct and liver between A and ligation groups on the 30th and 90th day after operation (Plt;0.05). ConclusionDuring cholecystectomy, immediate removal of common bile duct ligation doesn’t affect shortterm results, but the long-term results are bile duct stricture and obstruction.
【
Abstract
】
Objective
To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases)
，
vague pain of epigastric zone (11 cases)
，
abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases)
，
bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases)
，
aberrant bile-duct fistula (9 cases)
，
and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce
，
and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC
，
and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.
ObjectiveTo investigate the feasibility and advantages of general laparoscopic cholecystectomy and gynecologic uterus and attachment surgery at the same time.
MethodsSixty patients with gallbladder stones combined with ovarian cysts, benign gynecological disease or fallopian tube adhesions aged between 35 and 55 were chosen from the department of General Surgery and Gynecology and Obstetrics to be the study subjects between January 2009 and December 2013. The inclusion criteria included: gallbladder stones; gallbladder wall thickness <0.5 cm; non-acute inflammation; symptomatic gynecological diseases; and tumor size between 5.0 and 10.0 cm. Based on similar age, body mass, and histological type, the patients were divided into laparoscopic surgery (GLS) group and staging surgery group (control group) according to the will of the patients. The anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs were detected for comparison between the two groups.
ResultsThe first-time operation was successful in all the patients in the CLS group, with two cases of abnormal liver function, which were cured within 5-6 days. In the control group, 2 cases of reoperation were transferred to laparotomy due to umbilical and peritoneal adhesions, and both of them were cured and discharged from hospital without incision infection or iatrogenic tissue and organ damage. CLS group had significant advantages in anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs over the control group (P<0.05).
ConclusionThe combined gynecologic laparoscopic surgery is feasible, safe, mini-invasive, and economical.
ObjectiveTo study the relationship between cholecystectomy and Helicobacter pylori （Hp） infection. MethodsOne hundred and eleven patients with cholecystolithiasis were chosen as the investigation group, while 577 patients with upper digestive tract symptoms without cholecystolithiasis as the control group. All the patients took the 13C breath test to determine whether they were infected by Hp. All the patients with Hp infection continued eradical therapy for Hp infection for one course after cholecystectomy and were followed up on outpatient basis. ResultsThe infection rate in the investigation group was 45.9%, while 27.4% in the control group. During the 3 to 6 months of followup for the patients undergoing eradical therapy for Hp infection, we found no patient complaining of epigastric pain, malaise, belching and nausea. ConclusionThe infection rate of Hp in patients with cholecystolithiasis is high, Hp may be one of the factors causing “postcholecystectomy syndrome”. Eradical therapy for Hp after cholecystectomy will help improve the effects of operation.
