摘要:目的:探討腹腔鏡膽囊大部分切除在復雜膽囊結石手術中應用的可行性及安全性。方法:回顧性分析2003年1月至2008年10月間41例行腹腔鏡膽囊部分切除術的復雜膽囊結石病人。行腹腔鏡膽囊切除術指征為:膽囊管不能明確辨認時,諸如:膽囊積膿、Mirris綜合征、Calot三角致密粘連呈“冰凍樣”、萎縮性膽囊等。手術方法為:切除膽囊前壁,取凈結石,腹腔置管引流。結果:41例復雜膽囊結石病人中1例中轉開腹手術外,其余全部在腹腔鏡下完成,手術時間為45～145分鐘,平均(57.42±19.41)分鐘,1例術后出現膽漏,其余術后住院時間為2～7天。 結論:在膽囊三角不能安全辨認前提下,對于復雜膽囊結石行腹腔鏡膽囊部分切除術是一種安全的手術方式,不但能簡化手術、降低手術風險,而且能避免行開腹手術治療。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
Objective
To investigate clinical efficacy of laparoscopic cholecystectomy via left side approach for patients with acute cholecystitis.
Methods
One hundred and twenty patients with acute cholecystitis from January 2015 to May 2017 were collected. All of the patients were divided into observation group and control group according to the operative mode, with 60 cases in each group. In the observation group, the patients were treated by laparoscopic cholecystectomy via left side approach using the ligation-free technique to the main trunk of the cystic artery; in the control group, the patients were treated by the conventional laparoscopic cholecystectomy. After treatment, the operative situation, postoperative recovery, and incidence of postoperative complications were compared between these two groups.
Results
Compared with the control group, the operative time, first anal exhaust time, hospitalization stay, leukocytes recovery time, and coagulation function recovery time were shortened and the intraoperative bloods loss was reduced in the observation group, the differences were statistically significant (P<0.05). Furthermore, the overall postoperative complication incidence rate of the observation group was significantly lower than that of the control group (P<0.05).
Conclusion
For patients with acute cholecystitis, laparoscopic cholecystectomy via left side approach using ligation-free technique to main trunk of cystic artery is reliable and safe, which can effectively improve operative situation, shorten operative time, promote recovery of patient, and reduce incidence of postoperative complications.
ObjectiveTo explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.MethodsA total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group (43 cases) and the jaundice-free control group (control group, 61 cases) according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored.ResultsThe ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group (P<0.05). In addition, the hospital stay in the jaundice group was shorter than that of the control group (P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications (included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups (P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index (CCI), and ratio of CCI≥20 (P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications (P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications (P>0.05).ConclusionPreoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.
Objective
To explore the feasibility of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis, and to provide evidence based medicine for clinical treatment.
Methods
A total of 160 cases of acute cholecystitis who received treatment in our hospital from Jan. 2012 to Dec. 2015 were randomly divided into single incision group (n=80, received single incision laparoscopic cholecystectomy) and three incisions group (n=80, received three incisions laparoscopic cholecystectomy). The clinical and laboratory indexes were compared between the 2 groups.
Results
Compared with the three incisions group, there were statistically significant differences in the operation time, incision pain score, and subjective satisfaction, which were better in single incision group (P<0.05). But there was no significant difference in the blood loss, bed time, anal exhaust time, recovery time of intestinal peristalsis, hospitalization time, incidence of complication (including abdominal infection, bile duct injury, biliary fistula, and incision infection), ratios of T cell subsets (including CD3, CD4, and CD8 T cell), levels of immunoglobulin (including IgA, IgG, and IgM), and level of C reactive protein (P>0.05).
Conclusions
The effectiveness of single incision laparoscopic cholecystectomy is as good as three incisions laparoscopic cholecystectomy, but this single incision laparoscopic surgery is difficult, and its indications should be cautious. Single incision laparoscopic cholecystectomy is more suitable for patients undergoing elective cholecystectomy.
ObjectiveTo compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.MethodsWe searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.ResultsA total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.ConclusionsBoth LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.
摘要:目的:探討腹腔鏡膽囊切除術(laparoscopic cholecystectomy, LC)后發生嚴重并發癥的原因、治療措施和經驗教訓。方法:分析 2007 年 8 月至2009 年 4月期間華西醫院膽道外科收治的LC術后發生嚴重并發癥的7例患者的臨床資料。結果:2例繼發性膽總管結石合并化膿性膽管炎患者,采用內鏡下十二指腸乳頭切開(endoscopic sphincterotomy, EST)取出結石;3例膽道損傷患者,均進行肝門膽管成形和肝總管空腸吻合術;1例絞窄性腸梗阻患者,切除壞死空腸管后,行空腸對端吻合術;以上6例患者均順利出院,隨訪8～20個月,均生活良好。1例患者LC術后發生肺動脈栓塞,積極搶救后因呼吸衰竭而死亡。結論:術中仔細輕柔的操作以及辯清肝總管、膽總管與膽囊管的三者關系是預防LC術后發生嚴重并發癥的關鍵。合理可行的治療措施是提高發生并發癥的患者生活質量的保障。LC術時,膽道外科醫生思想上要高度重視,不可盲目追求速度,必要時及時中轉開腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
Objective To explore the feasibility and safety of daytime laparoscopic cholecystectomy in high-altitude areas. Methods Clinical data of patients with gallstones undergoing laparoscopic cholecystectomy admitted to Qinghai Red Cross Hospital between January and December 2023 were retrospectively collected. Patients were divided into daytime surgery group and routine surgery group according to their hospitalization method. The gender, age, ethnicity, American Society of Anesthesiologists classification, comorbidities, postoperative pain, postoperative indwelling drainage tube, postoperative nausea and vomiting, overall satisfaction, length of hospital stay, and hospitalization costs of the two groups of patients were compared. Results A total of 95 patients who underwent daytime surgery and 186 patients who underwent routine surgery were included. There was no statistically significant difference in gender, age, comorbidities, or American Society of Anesthesiologists classification between the two groups of patients (P>0.05). The proportion of Han patients in the daytime surgery group was higher than that in the routine surgery group (69.5% vs. 34.4%, P<0.05). All patients successfully completed the surgery without any serious complication. There was no statistically significant difference in postoperative indwelling drainage tube, postoperative nausea and vomiting, postoperative pain, or overall satisfaction between the two groups of patients (P>0.05). The length of hospital stay [(1.03±0.17) vs. (5.30±1.53) d] and hospitalization expenses [(8104.97±660.65) vs. (8947.82±746.19) yuan] in the daytime surgery group were lower than those in the routine surgery group (P<0.05). Conclusion Daytime laparoscopic cholecystectomy is safe and feasible for patients in high-altitude areas without comorbidities or with stable control of comorbidities, and is beneficial for reducing the medical burden on patients.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
