Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be...Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.展开更多
目的比较腹腔镜与开腹手术在外伤性脾破裂患者中应用效果的差异。方法计算机检索Pub Med、Web of Science、中国知网、万方数据库及维普数据库中发表的关于腹腔镜手术与开腹手术治疗外伤性脾破裂的对比研究性文献,检索时间为2007年1月至...目的比较腹腔镜与开腹手术在外伤性脾破裂患者中应用效果的差异。方法计算机检索Pub Med、Web of Science、中国知网、万方数据库及维普数据库中发表的关于腹腔镜手术与开腹手术治疗外伤性脾破裂的对比研究性文献,检索时间为2007年1月至2017年1月,采用Stata 12.0软件进行meta分析。结果 (1)术中情况:与OS组相比,LS组患者的手术时间更短[SMD=–0.71,95%CI为(–1.12,–0.30),P=0.001],术中出血量更少[SMD=–1.53,95%CI为(–2.28,–0.78),P<0.001]。(2)术后情况:与OS组比较,LS组患者的术后肛门排气时间[SMD=–2.47,95%CI为(–3.24,–1.70),P<0.001]、术后下床活动时间[SMD=–2.97,95%CI为(–4.32,–1.62),P<0.001]和住院时间[SMD=–1.68,95%CI为(–2.15,–1.21),P<0.001]均较短。(3)总并发症发生率和各并发症发生率:与OS组比较,LS组患者的术后总并发症发生率较低[OR=0.29,95%CI为(0.19,0.43),P<0.001]。与OS组比较,LS组患者的感染[OR=0.27,95%CI为(0.13,0.55),P<0.001]、腹腔积液[OR=0.36,95%CI为(0.13,1.00),P=0.049]、出血[OR=0.29,95%CI为(0.10,0.90),P=0.032]、肠梗阻[OR=0.34,95%CI为(0.13,0.90),P=0.030]、切口脂肪液化[OR=0.27,95%CI为(0.08,0.94),P=0.040]和切口裂开[OR=0.17,95%CI为(0.03,0.96),P=0.045]的发生率均较低(P<0.05),但2组患者的脾切除后发热[OR=0.41,95%CI为(0.13,1.27),P=0.123]、胰瘘[OR=0.40,95%CI为(0.06,2.63),P=0.343]、肝功能损害[OR=0.36,95%CI为(0.10,1.34),P=0.127]和血栓形成[OR=0.33,95%CI为(0.09,1.22),P=0.097]发生率比较差异均无统计学意义。结论腹腔镜手术不仅能够显著降低外伤性脾破裂患者多种并发症的发生率,还能有效加快其术后康复,因而外伤性脾破裂患者行腹腔镜手术是安全和有利的。展开更多
文摘Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.
