腹腔镜切除胆囊手术治疗急性结石性胆囊炎的疗效观察

目的探讨腹腔镜胆囊切除术在急性结石性胆囊炎中的应用效果。方法选取2012年8月—2015年5月我院治疗的222例急性结石性胆囊炎患者,并根据随机数字表法将其分为对照组(n=111例)与观察组(n=111例),对照组接受开腹胆囊切除术治疗,观察组接受腹腔镜胆囊切除术治疗。对比2组患者的治疗效果。结果 2组患者在手术时间与住院时间、术中出血量、肛门排气时间以及下床活动时间方面对比差异具有统计学意义(P<0.05)。观察组患者的治疗总有效率为98.20%,明显高于对照组的81.09%(P<0.05)。2组并发症发生率比较,观察组明显优于对照组(P<0.05)。结论腹腔镜胆囊切除术治疗急性结石性胆囊炎具有手术时间短、安全性高、创伤面小等优势。

急性结石性胆囊炎腔镜胆囊切除手术时机的合理选择探讨

目的探讨急性结石性胆囊炎腔镜胆囊切除手术时机的合理选择及临床效果。方法选取我院2014年11月~2016年2月收治的实施腔镜胆囊切除手术的急性结石性胆囊炎患者186例,依据不同手术时机分为对照组和观察组各93例。对照组患者采取延期手术,观察组采取早期急诊手术,观察对比两组组织粘连程度、术后疼痛程度、切合愈合情况、中转开腹率及术后并发症发生率。结果观察组平均手术时间、排气时间、及引流管放置时间均显著优于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率显著低于对照组,差异有统计学意义(P<0.05);两组中转开腹率比较无明显差异(P>0.05)。结论早期急诊手术治疗急性结石性胆囊炎,临床效果显著,损伤更小,有利于术后恢复,值得推广。

急性结石性胆囊炎腔镜胆囊切除手术时机的选择

目的:分析急性结石性胆囊炎行腔镜切除手术时机的选择。方法:2012年5月-2014年5月收治行腔镜切除的急性结石性胆囊炎患者60例,根据治疗方法与手术时间分为延期手术组与急诊手术组,各30例。对比两组住院时间、排气时间、引流管放置时间、并发症、中转开腹率以及手术时间。结果:在手术时间、引流管放置时间、排气时间以及住院时间方面,急诊手术组明显优于延期手术组,差异有统计学意义(P<0.05)。急诊手术中,中转开腹1例(3.33%),发生并发症2例(6.67%);延期手术组中,中转开腹4例(13.33%),发生并发症5例(16.67%),急诊手术组明显低于延期手术组,差异有统计学意义(P<0.05)。结论:对急性结石性胆囊炎患者采取急诊腔镜胆囊切除术是可行的,对患者造成创伤小,明显缩短住院时间,术后并发症减少,是治疗的首选方法,具有临床应用价值。

腔镜胆囊切除手术治疗急性化脓性胆囊炎的效果

探析腔镜胆囊切除手术(LC)治疗急性化脓性胆囊炎的效果。方法:2018年3月~2021年3月,在我院就诊的急性化脓性胆囊炎患者中选取120例,均接受LC治疗,分析治疗效果。结果:120例患者中含2例无效、68例有效、50例显效,分别占比1.7%、56.7%、41.7%,总有效118例,有效率98.3%。肠道恢复功能的时间(15.64±2.23)h、住院时间(4.53±1.26)d、术中出血量(15.65±3.24)ml、手术时间(38.65±10.23)min。患者中出现2例切口渗血,占比1.7%,2例胆管损伤,占比1.7%,2例切口化脓,占比1.7%,合计6例并发症,占比5.0%。结论:急性化脓性胆囊炎治疗时选择LC,取得了确切的疗效,值得应用。

Incidental gallbladder cancer during laparoscopic cholecystectomy:Managing an unexpected finding

AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.

Patients' quality of life after laparoscopic or open cholecystectomy

Objective: This study was aimed at evaluating and comparing the quality of life in patients who underwent laparo-scopic and open cholecystectomy for chronic cholecystolithiasis. Methods: The study included 25 patients with laparoscopic cholecystectomy (LC group) and 26 with open cholecystectomy (OC group). The quality of life was measured with the Gastrointestinal Quality of Life Index (GLQI) preoperatively, thereafter regularly at 2, 5, 10 and 16 weeks after the operation. Results: The mean preoperative overall GLQI scores were 112.5 and 110.3 in LC and OC group respectively (P>0.05). In the LC group, the mean overall GLQI score reduced slightly to 110.0 two weeks after the operation (P>0.05). The LC group showed significant improvement in overall score and in the aspects of symptomatology, emotional and physiological status from 5 to 16 weeks postoperatively. In the OC group, the GLQI score reduced to 102.0 two weeks after surgery (P<0.05). Significant reductions were shown in the aspects of symptomatology, physiological and social status. The GLQI scores returned to the preoperative level of 115.6 ten weeks after the operation (P>0.05). The patients experienced significant improvements of GLQI sixteen weeks after OC operation (P<0.01-0.05). Within the 10 postoperative weeks, the LC group had significantly higher GLQI scores than the OC group (P<0.05). Conclusions: LC can improve the quality of life postoperatively better and more rapidly than OC. The assessment of quality of life assessment is a valid method for measuring the effects of surgical treatment.

Effect of acupoint injection of Neostigmine on gastrointestinal function after cholecystectomy

Objective： To observe the effect of acupoint injection with Neostigmine Methylsulfate at Zusanli（ST 36） on gastrointestinal function of patients after laparoscopic cholecystectomy.Methods： Totally 120 patients undergone laparoscopic cholecystectomy were randomized into an acupoint injection group, a muscular injection group, and a blank control group at 1：1：1 by random number table, 40 cases in each group. The blank control group was intervened by conventional post-operation treatment, the acupoint injection group was by acupoint injection with Neostigmine Methylsulfate 2 m L at bilateral Zusanli（ST 36） in addition to the treatment given to the blank control group, and the muscular injection group was by muscular injection with Neostigmine Methylsulfate 2 m L in addition to the treatment given to the blank control group. The two injection groups both received injection twice a day, totally for 3 d at most. The restored time of bowel sounds, initial flatulence time, defecation time and clinical efficacy were observed. Results： After treatment, there were significant differences in comparing the restored time of bowel sounds among the three groups（F=17.30, P〈0.05）, the acupoint injection group and muscular injection group were significantly different from the blank control group（P〈0.05）, and there was a significant difference between the acupoint injection group and muscular injection group（P〈0.05）; there were significant differences in comparing the initial flatulence time among the three groups（F=19.12, P〈0.05）, and the acupoint injection group was significantly different from the muscular injection group and the blank control group（P〈0.05）; there were significant differences in comparing the initial defecation time among the three groups（χ^2=21.23, P〈0.05）, while the difference between the acupoint injection group and muscular injection group was statistically insignificant（P〈0.05）. The total effective rate was 87.5% in the acupoint injection group, versus 72.5% in the muscular injection group and 60.0% in the blank control group, and there were significant differences among the three groups（P〉0.05）. Conclusion： Acupoint injection with Neostigmine Methylsulfate at Zusanli（ST 36） can shorten the restored time of bowel sounds and flatulence time in patients undergone laparoscopic cholecystectomy, and the efficacy is more significant compared to muscular injection with Neostigmine Methylsulfate.