Objective To summarize the treatment experience for concomitant diseases of other abdominal organs in laparoscopic cholecystectomy （LC）. Methods The clinical data of 176 patients with LC and concomitant diseases of other abdominal organs were analyzed retrospectively， including preoperatively diagnosed cases （such as 53 with liver cyst， 15 with choledocholithiasis， 7 with chronic appendicitis， 5 with inguinal hernia， 4 with renal cyst， and 6 with ovarian cyst） and intraoperatively diagnosed cases （such as 72 with abdominal cavity adhesion， 4 with internal fistula between gallbladder and digestive tract， 3 with Mirizzi syndrome， and 7 with unsuspected gallbladder carcinoma）. Results All the operation were successfully completed in 176 patients without severe complications， including 53 cases treated with LC plus fenestration of hepatic cyst， 15 with choledocholithotomy， 7 with appendectomy， 5 with tension free hernia repair， 4 with renal cyst fenestration， 6 with oophorocystectomy， 72 with adhesiolysis， 3 with fistula resection plus intestine neoplasty， 2 with intraoperative cholangiography plus choledocholithotomy， 5 with LC plus gallbladder bed complete burning， and 4 cases treated with conversion to open surgery （1 with intestinal fistula repair， 1 with choledocholithotomy， and 2 with radical resection for gallbladder carcinoma）. Conclusions It is safe and effective to treat gallbladder diseases complicated with other concomitant diseases simultaneously with laparoscopic operation， if the principles of surgical operation are followed and the indications and applicable conditions are strictly followed. And conversion to open surgery is necessary.
From the March of 1993 to the May of 1994, we had performed laparoscopic cholecystectomy (LC) for 200 patients of the age ranged 19-77 years. In these cases, 12 had previous abdominal surgery; 3 cases had hepatic cysts; 11 cases had stones in the neck of gall bladders. We had successfully performed LC for 190 cases (95%). But we also had some unsuccesful experiences, including accidental injury to the stomach or duodenum, and bleeding from cystic arteris of the gallbladder. Operation (LC) was abandoned in one patient because of severe cardiac arrhyshmia developed during operation, and billiary tract injury was found postoperatively in three patients with no postoperative death. The operative indications and technical problems of LC are discussed in detail and measures in avoiding injury to billiary or GI tract from LC are introduced.
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 evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.
ObjectiveTo investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo-scopic cholecystectomy(ALC). MethodsThe clinical data of patients who divided into ALC group(678 cases) and in-patient laparoscopic cholecystectomy(IPLC) group(1 534 cases) in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi-talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. ResultsThere were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups(P > 0.05). The conversion rate(0.44%), and hospitalization time[(1.2±0.5)d] of the ALC group were significantly lower or shorter than those of IPLC group[3.19%, (4.8±1.3) d], P < 0.05. The direct, indirect health care costs, and the total costs of the ALC group were (6 555.6±738.7), (230.0±48.0), and (8 856.0±636.0) yuan, respec-tively; and lower than those of the IPLC group[(7 863.71, 014.6), (973.0±136.5), and(8 856.0±636.0)yuan], P < 0.05. ConclusionALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed turnover, and increase the efficiency in the use of health resource.
As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine (EBM), which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking. Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
ObjectiveTo compare the advantages and disadvantages of transumbilical single port (TUSP) and conventional laparoscopic cholecystectomy (LC). MethodsThe clinical data of 45 patients underwent elective LC were analyzed, 20 patients with TUSP LC (TUSP-LC group), 25 patients with conventional LC (conventional LC group). The operation time, Child-Pugh score and painkiller application frequency within three days after operation, the first time of out of bed and hospital stay after operation, intraoperative blood loss, chronic pain within one month after surgery were compared between two groups. ResultsAll cases were operated successfully except one patient in the conventional LC group. The frequency of painkiller application within three days after operation and postoperative hospital stay in the TUSP-LC group were better than those in the conventional LC group (Plt;0.05). There were no significant differences on postoperative chronic pain of surgical area within 1 month and Child-Pugh score between two groups (Pgt;0.05). The operation time and intraoperative blood loss in the conventional LC group were less than those in the TUSP-LC group (Plt;0.05, Plt;0.01). ConclusionTUSP LC has the advantages of small wound, slight pain, and fast recovery.
Objective To observe effect of self-designed drug-loaded nanofilm in preventing postoperative peritoneal cavity adhesion during cholecystectomy in New Zealand white rabbit. Methods The 40 New Zealand white rabbits were randomly divided into blank control group, chitosan group, nanofilm group, and drug-loaded nanofilm group using random number table, the peritoneal cavity adhesions after cholecystectomy at different time (on day 7, 14, 21, and 28) were observed among these 4 groups. Results The adhesion of gallbladder forssa was serious in the blank control group and the adhesion situation had obviously improved among the other three groups, furthermore, the adhesion of the drug-loaded nanofilm group was the slightest. The adhesion score was significantly decreased in the chitosan group, the nanofilm group, or the drug-loaded nanofilm group as compared with the blank control group (P<0.05), which in the drug-loaded nanofilm group was significantly decreased as compared with the chitosan group (P<0.05) or the nanofilm group (P<0.05), which had no significant difference between the chitosan group and the nanofilm group (P>0.05). The nanofilm was degraded on day 14 after surgery and basically completely degraded on day 28 after surgery. The nanofilm degradation points had no significant differences between the nanofilm group and the drug-loaded nanofilm group at different time (P>0.05). Conclusions Drug-loaded nanofilm could prevent postoperative peritoneal cavity adhesion from physical barrier and drug therapy. It provides a new idea for prevention of peritoneal cavity adhesion after general surgery and research and development of new material to prevent peritoneal cavity adhesion in future.
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.