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双语推荐：胆囊切除术

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目的 探讨残余胆囊的病因及诊治方法. 方法 回顾性分析52例有症状、采取手术治疗残余胆囊患者的诊治经过,分析残余胆囊的发病原因,不同治疗方案对残余胆囊的诊治经验.结果 52例患者术前依据超声、CT或MRI等均获明确诊断,且均行手术治疗.其中10例行腹腔镜残余胆囊切除术,32例行开腹残余胆囊切除术,7例行残余胆囊切除加胆道探查术,1例行残余胆囊切除、胆道探查、肝左外叶切除术,1例行残余胆囊切除、胆道探查、胆肠吻合术,1例行残余胆囊癌根治术.患者均恢复良好,术后无明显并发症出现.结论 残余胆囊的诊断并不困难,手术切除却有一定难度,术中超声及胆道镜的应用有较大辅助治疗价值.
Objective To evaluate the diagnosis and treatment of residual gallbladder.Methods The diagnosis of residual gallbladder depends on a history of previous cholecystectomy and postoperative existent symptoms suggesting cholecystitis.In this series the diagnosis was finally established by ultrasonography and laparotomy in 52 cases.Results Ten cases received laparoscopic residual cholecystectomy,32 cases underwent residual cholecystectomy,7 cases did residual cholecystectomy plus common bile duct exploration,1 case was treated with residual cholecystectomy,common bile duct exploration and left lateral lobe hepatectomy,1 case with residual cholecystectomy,common bile duct exploration,cholangioenterostomy,1 case by radical resection of residual gallbladder cancer.Conclusions Residual gallbladder is a secondary disease,diagnosis is not difficult,surgery has certain difficulty,the application of intraoperative ultrasound and choledochoscope has great value.

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目的：总结腹腔镜胆囊切除术中、术后意外胆囊癌的临床特点及诊治经验，提高意外胆囊癌的根治性切除率和远期疗效。方法回顾性分析64例腹腔镜胆囊切除术意外胆囊癌患者的临床资料，提高意外胆囊癌根治性切除率及远期疗效的诊治方案。结果64例意外胆囊癌中行腹腔镜胆囊切除术28例，腹腔镜胆囊切除术追加根治性切除术36例，均获得随访，随访时间2～132个月。腹腔镜胆囊切除术组和腹腔镜胆囊切除术追加根治性切除术组术后生存期比较差异有统计学意义（35与46个月，P＜0．05）。按不同TNM分期分层，Tis＋T1a期患者腹腔镜胆囊切除术和腹腔镜胆囊切除术追加根治性切除术术后生存期比较差异无统计学意义（84与132个月，P＞0．05），T1b期、T2期、T3期患者腹腔镜胆囊切除术和腹腔镜胆囊切除术追加根治性切除术术后生存期比较差异均有统计学意义（43与86个月；31与52个月；18与36个月，P＜0．05）。结论 Tis和T1a期意外胆囊癌行腹腔镜胆囊切除术即可达到根治目的， T1 b期意外胆囊癌术式选择有待进一步研究， T2、T3期者为改善患者远期疗效应追加根治性手术。
Objective To summarize the clinical features and diagnostic and therapeutic experiences of unexpected gallbladder carcinoma ( UGC) during or after laparoscopic cholecystectomy ( LC) to boost radical resection rate and long-term efficacy.Methods The clinical data of 64 UGC patients undergoing LC were retrospectively analyzed.Results The procedures included LC ( n=28 ) and LC plus radical resection ( n =36 ) .The follow-up period was 2 -132 months.The inter-group differences were statistically significant in post-operative survival rate (35 vs 46 months, P 0.05) .However the differences for pT1b, pT2 and pT3 grades were statistically significant (43 vs 86 months; 31 vs 52 months; 18 vs 36 months, P<0.05).Conclusions Identification of high-risk factors and intraoperative rapid pathologic examination improve radical resection rate.Radical cure via LC may be achieved for pTis and pT1a stages of UGC.For pT1b stage of UGC, optimal surgical procedures need further explorations.For st

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探讨基层医院开展小切口胆囊切除术的可行性研究。方法:2008年1月-2012年1月收治小切口胆囊切除术患者43例与常规胆囊切除术患者38例,对两组进行比较。结果:小切口胆囊切除成功41例(95.35%),术中延长手术切口2例(4.65%);小切口组切口一期愈合42例(97.67%),平均住院(5.5±0.6)d,常规胆囊切除组切口一期愈合32例(84.21%),平均住院(10.2±0.4)d。结论:小切口胆囊切除术切口一期愈合率、平均住院天数等均显著优于常规胆囊切除术,值得在基层医院推广。
Objective:To explore the feasibility research of launching small incision cholecystectomy in the primary hospital. Methods:43 cases with small incision cholecystectomy and 38 cases with routine cholecystectomy were selected from January 2008 to January 2012.The patients in two groups were compared.Results:Small incision cholecystectomy was successful in 41 cases(95.35%);the operative incision was extension during operation in 2 cases(4.65%).42 cases(97.67%) of incision were primary healing in the small incision group;the average hospitalization was (5.5±0.6) days.32 cases(84.21%) of incision were primary healing in the routine cholecystectomy group;the average hospitalization was (10.2±0.4) days.Conclusion:The primary healing rate of incision and average hospitalization days of small incision cholecystectomy are significantly better than those of the routine cholecystectomy.It is worth to be popularized in primary hospital.

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目的探讨脐周三孔法腹腔镜胆囊联合阑尾切除术的可行性。方法 2012年3~12月行脐周三孔腹腔镜胆囊联合阑尾切除术42例。全身麻醉。采用平卧位,气腹压力12~14 mm Hg(1 mm Hg=0.133 kPa)。以脐为中心,沿脐周皮肤皱褶线画圆,从5、8、1点方向分别置入10、5、10 mm trocar,入镜观察胆囊和阑尾情况,先行胆囊切除后再行阑尾切除术。结果 42例采用普通腹腔镜器械经脐周行三孔胆囊切除联合阑尾切除术取得成功。手术时间60~130 min,平均78 min。40例术后随访2~12个月(平均7个月),腹壁瘢痕不明显,无并发症发生。结论脐周三孔腹腔镜胆囊联合阑尾切除术安全可行,在有条件的医院可以作为腹腔镜胆囊切除联合阑尾切除的改进术式推广。
Objective-To-evaluate-the-feasibility-of-the-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-.-Methods-From-March-2012-to-December-2012,-a-total-of-42-cases-subject-to-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-in-this-hospital-were-retrospectively-analyzed-.Under-general-anesthesia-,-the-patients-were-maintained-at-recumbent-position-,-with-a-pneumoperitoneum-pressure-of-12-14-mm-Hg.With-the-navel-as-the-center-,-10-mm,-5-mm,-and-10-mm-trocars-were-introduced-at-5,-8,-and-1-o’-clock-direction-along-the-circumference-of-periumbilical-skin-fold-,-respectively-.After-observation-and-exploration-,-cholecystectomy-and-appendectomy-were-successively-performed-.-Results-All-the-patients-were-successfully-treated,-without-any-complications.The-operation-time-was-60-130-min-(mean,-78-min).A-follow-up-observation-for-2--12-month-(-mean,-7-month-)-was-conducted-in-40-cases.No-obvious-scars-or-complications-were

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目的：对应用开腹胆囊切除术与微创胆囊切除术两种方式临床效果进行对比研究。方法：将72例接受胆囊切除手术的患者随机分为对照组和治疗组，平均每组36例。采用开腹胆囊切除术对对照组患者实施治疗；采用微创胆囊切除术对治疗组患者实施治疗。观察两组临床疗效。结果：治疗组患者胆囊切除术治疗效果明显优于对照组；手术操作时间和术后住院治疗时间明显短于对照组。结论：应用微创胆囊切除术临床效果较好，值得推广应用。
Objective To compare and research the clinical effect of painless cholecystectomy and open cholecystectomy for pa-tients receiving cholecystectomy.Methods 72 cases receiving cholecystectomy in our hospital were divided into two groups randomly, the control group and the treatment group,each group for 36 cases.The control group was treated with open cholecystectomy,and the treatment group was treated with painless cholecystectomy.Results The treatment effect of the treatment group was better than that of the control group.The operation time and length of stay after operation of the treatment group was shorter than that of the control group. Conclusion Applying painless cholecystectomy for patients needing cholecystectomy has evident clinical effect.

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目的：：探讨单孔腹腔镜胆囊切除术的临床治疗效果。方法：选取2010年6月~2014年6月于本院治疗的66例患者作为研究对象，随机分为单孔腹腔镜胆囊切除术组(32例)，传统四孔法腹腔镜胆囊切除术组(34例)。针对2组术后的疼痛程度、肠功能恢复时间、并发症的发生率进行统计学比较。结果：单孔腹腔镜胆囊切除组在术后疼痛程度方面明显低于传统四孔法腹腔镜胆囊切除术组，术后肠功能恢复时间方面明显短于传统四孔法腹腔镜胆囊切除术组，差异有统计学意义(P0.05)。结论：单孔腹腔镜胆囊切除术较传统四孔法腹腔镜胆囊切除术临床疗效显著，术后疼痛程度轻、术后恢复快、瘢痕隐蔽，建议在普外医师中推广应用。
there was no significant difference (P>0. 05). conclusion: SPLC compared with CLC,remarkable curative effect, postoperative mild pain, faster postoperative recovery, hidden scars, shows the applied worthy of this new technology in clinical field.

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目的探讨腹腔镜胆囊次全切除术的可行性,总结困难型腹腔镜胆囊切除术的经验,尤其是腹腔镜胆囊次全切除理念在困难型腹腔镜胆囊切除术中的体现及应用。方法回顾分析我院2008年1月至2013年10月所行腹腔镜胆囊次全切除病例,并以2011年5月为时间节点分为A组(节点前时段)、B组(节点后时段),分别比较前后两组的(胆囊切除实行专病专治),手术时间、术后住院时间、术中出血量。结果 B组手术时间(78.1±6.6)min少于A组(97.5±7.3)min,B组术后住院时间(3.5±0.4)d少于A组(5.6±0.5)d,出血量B组(68.9±7.2)ml多于A组(56.7±7.7)ml。差异均有统计学意义。结论腹腔镜胆囊次全切除应成为腹腔镜术者的常规理念;熟练掌握腹腔镜技术、积累一定经验后,腹腔镜胆囊次全切除可作为常规手术操作应用于临床。
Objective To discuss the fessibility of laparoscopic subtotal cholecystectomy (DLC), especially the use of the idea about laparoscopic subtotal cholecystectomy(LSC). Methods A retrospective study covering LSC cases from January 2008 to October 2013 was performed,and May 2011 was time point (cholecystectomy was done by dedicated department),Operative time (OT)、postoperative hospital stay (PHS) and blood loss(BL) during two periods were compared. Results OT during latter period (78.1± 6.6)min was less than anterior(97.5±7.3)min,PHS(3.5±0.4)d during latter period was less than anterior (5.6±0.5)d,BL during latter period(68.9±7.2)ml was more than anterior(56.7±7.7)ml. The differences were statistical significance.Conclusions LSC should be a routine concept to the laparoscopic surgeons.For surgeons who expertly grasp laparoscopic tecniques,have enough experiences,LSC can be routine procedure during clinical operation.

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目的腹腔镜技术处理胆囊变异的可行性及其临床疗效。方法回顾性分析1例先天性胆囊变异并结合相关文献，对此病的诊断和治疗进行临床研究。结果入院诊断慢性结石性胆囊炎，行腹腔镜胆囊切除术。术中发现胆囊变异，行逆行法切除胆囊。患者术后痊愈出院。结论胆囊变异给腹腔镜胆囊切除术带来一定困难，术中应重视胆囊可能的变异情况，只要能及时发现胆囊变异并采取相应措施，腹腔镜下处理胆囊变异是安全有效的。术前超声检查诊断胆囊管解剖变异有较高的准确性。
Objective Laparoscopic treatment feasibility and clinical effects of variation of gal bladder. Methods A retrospective analysis of 1 cases of congenital variation of gal bladder and unifies the related literature, the diagnosis and treatment of disease in clinical research. Results The admission diagnosis of chronic calculous cholecystitis, laparoscopic cholecystectomy. Found that the variation of gal bladder surgery, retrograde excision of gal bladder. The patients recovered after the operation. Conclusion Laparoscopic cholecystectomy gal bladder variation to bring certain dif iculty, should pay at ention to the possible variation of gallbladder surgery, as long as can be found in time variation of gal bladder and take corresponding measures, laparoscopy is a safe and ef ective treatment of gal bladder variation. Preoperative ultrasonography in the diagnosis of cystic duct anatomic variation with high accuracy.

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探讨胆囊切除术并发症的发生原因及其预防对策。方法:2003年12月-2013年12月收治胆囊切除术患者1 542例,其中开腹胆囊切除手术(OC)患者861例,腹腔镜胆囊切除手术(LC)患者681例。结果:其中胆管损伤1例,十二指肠损伤1例,切口脂肪液化3例,切口感染3例,空肠损伤1例,胆囊管残留结石1例,胆总管残留结石1例,胆漏1例,出血2例,LC中转开腹手术5例,余手术进展顺利。结论:术前对患者的病情评估、合理选择病例、恰当掌握好手术时机、谨慎规范的手术操作、果断及时地中转开腹可有效地防止和减少胆囊切除术并发症的发生率,尤其是在防范腹腔镜胆囊切除术后所致的严重并发症非常重要。
Objective:To explore the causes and the preventive measures of complications of cholecystectomy(LC and OC). Methods:1542 cases with cholecystectomy were selected from December 2003 to December 2013.861 cases were cholecystectomy operation.681 cases were laparoscopic cholecystectomy operation.Results:Among them,1 case had bile duct injury.1 case had duodenal injury.3 cases had incision fat liquefaction.3 cases had incision infection.1 case had cystic duct jejunum injury.1 case had residual common bile duct calculi.1 case had residual stones.1 case had bile leakage.2 cases had hemorrhage.5 cases were converted to open operation in LC.The rest of the operation was smooth.Conclusion:Before operation,the evaluation of patients condition,proper selection of cases,appropriate master operation time,cautious operation specification,decisive and timely conversion to open surgery can effectively prevent and reduce the incidence of complications of cholecystectomy,especially in the prevention of s

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目的 探讨腹腔镜辅助下术中或术后意外发现的早期胆囊癌行根治术的可行性.方法 回顾性分析2007年1月至2013年8月在我科腹腔镜下胆囊切除术中或术后病理发现的34例原发性胆囊癌患者的临床资料.其中29例为术中快速病理确诊为胆囊癌,5例为术后病理确诊为Ⅰ期、Ⅱ期胆囊癌.结果 34例患者均成功完成了标准的胆囊癌根治术,其中20例Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者行腹腔镜下单纯胆囊切除术或根治性/扩大根治性胆囊切除术,9例中转开腹行根治性/扩大根治性胆囊切除术或联合肝段/叶切除的胆囊根治性切除术.5例单纯胆囊切除术后病理确诊为胆囊癌的患者再次行腹腔镜下胆囊癌根治性/扩大根治性手术.结论 胆囊癌Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者均应行根治性或扩大根治性胆囊切除术.行腹腔镜辅助下根治性或扩大根治性胆囊切除术短期治疗效果满意,5年生存率两者差异无统计学意义.且具有更低的疼痛不适率,更短的住院时间,可以达到与开腹同样的手术效果,达到了根治的要求.
Objective To explore the feasibility of radical cholecystectomy for early gallbladder car cinoma found during or after laparoscopic cholecystectomy.Methods A retrospective study was conducted on patients who received laparoscopic cholecystectomy between January 2007 to August 2013 and were diagnosed to have gallbladder cancer during or after the operation.There were 34 patients.In 29 patients intraoperative frozen section diagnosed gallbladder carcinoma.In 5 patients postoperative histopathological study diagnosed stage Ⅰ or Ⅱ gallbladder carcinoma.Results Surgery was conducted successfully on these 34 patients.In 20 patients with stage Ⅰ,Ⅱ and Ⅲ,the tumor had invaded the serosa,or into the liver with a depth of less than 2 cm,laparoscopic cholecystectomy alone or radical/extended radical cholecystectomy were carried out.In 9 patients,the laparoscopic surgery was converted to open surgery and these patients underwent cholecystectomy with resection of the adjacent liver s

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