目的 探讨内镜逆行胰胆管造影(ERCP)检查及内镜治疗在腹腔镜胆囊切除(LC)术前、术后的应用价值。 方法 对61例拟行LC的患者术前或术后行ERCP检查，发现异常再行内镜治疗。结果 LC术前行ERCP者42例中39例显影，其中37例伴有其他胆管疾病，占94.9%。术后行ERCP者19例均显影，总的插管成功率为95.1%。LC术前或术后42例行EST治疗，4例行EPBD，2例行ERBD，15例行ENBD，另4例在行ERCP检查后改开腹手术，取石成功率为92.9%。结论 诊治性ERCP在LC前、后的应用，对进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。
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.
目的 结合腹腔镜手术的特点，设计出部分顺逆结合法腹腔镜胆囊切除术(LC)，总结该法的应用体会。方法 介绍部分顺逆结合法LC的方法。在1 250例LC中有255例采用部分顺逆结合法切除胆囊，其中慢性胆囊炎146例，急性、亚急性胆囊炎65例，慢性萎缩性胆囊炎44例。结果 所有患者均获痊愈。术中发现胆囊三角区细小副肝管4例，胆汁渗漏3例，均予妥善处理，无严重并发症发生。结论 该法吸取了开腹顺逆结合法胆囊切除术的优点，又符合腹腔镜手术的特点，适用于胆囊三角解剖结构不清者的手术。该法对发现解剖变异及避免胆管损伤有一定的作用。
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.
Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007， 113 patients including chronic gallstone cholecystitis （n=55）, inactive cholecystolithiasis （n=46） and gallbladder polyps （n=12） were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation， 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC， 3 months and 6 months after LC were (5±2) mm, (8±2) mm and (6±2) mm respectively. And in chronic gallstone cholecystitis patients they were (5±2) mm, (9±2) mm and (6±2) mm respectively， in inactive gallstone cholelithiasis patients they were (5±2) mm, (8±2) mm and (6±2) mm respectively， and in gallbladder polyps ones they were (5±2) mm, (7±2) mm and (5±2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.
目的探讨腹腔镜与开腹胆囊切除术对患者肝功能及免疫功能的影响。 方法根据手术方式将84例胆囊良性病变患者分为腹腔镜胆囊切除术组（LC组，50例）及开腹胆囊切除术组（OC组，34例），比较2组患者手术前后肝功能及免疫功能指标的变化。 结果2组患者肝功能在手术前后不同时间点的差异均无统计学意义（P＞0.05）；LC组患者术后免疫功能各指标与术前比较无明显变化（P＞0.05），OC组CD3+、CD4+及CD4+/CD8+在术后1 d及3 d均较术前明显降低（P＜0.05），术后7 d恢复至术前水平（P＞0.05）。 结论LC术可引起患者术后肝功能短暂异常，但对免疫功能无明显影响，可作为胆囊切除的首选术式。
目的 探讨腹腔镜下联合胆道镜微创保胆取石术治疗胆囊结石的疗效。方法 解放军第452医院普外科2005年1月至2010年1月期间行腹腔镜保胆取石术治疗胆囊结石患者70例，与同期行腹腔镜胆囊切除术的患者对比，观察2组的手术时间、术中出血量、术后住院时间、住院费用及术后饮食恢复时间。结果 在术中出血量及术后饮食恢复时间上，保胆取石组明显少于或短于胆囊切除组（P＜0.05）；在手术时间、术后住院时间及住院费用上2组间差异无统计学意义（P＞0.05）。结论 相比胆囊切除术，腹腔镜联合胆道镜保胆取石术创伤较小且恢复较快，但是保胆取石术后结石的复发有待长期观察和研究。
目的:探讨腹腔镜胆囊切除术(LC)与内镜十二指肠乳头括约肌切开术(EST)联合应用治疗胆囊结石合并胆总管结石的临床效果。方法:回顾性分析我院开展的LC联合EST治疗胆囊结石合并胆总管结石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。结果:本组全部治愈,先行EST组56例,3例并发胰腺炎,3例出血,2例再发胆总管结石,先行LC组20例行EST11例,6例取石后未做括约肌切开,3例结石自行掉入肠道,1例出现胆道感染,1例胰腺炎,无出血及穿孔。结论:内镜治疗胆囊结石继发胆总管结石具有创伤小、效果好、并发症少、恢复快的的特点;先作EST可解除胆道梗阻、减轻炎症,并为LC创造条件,选择性先行LC后可减轻创伤,甚至不必做EST。
目的 探讨联合后-前胆囊三角入路在腹腔镜胆囊切除中的应用价值。方法 回顾性分析我院2007年1月至2010年1月期间经联合后-前胆囊三角入路解剖胆囊管及胆囊动脉行腹腔镜胆囊切除的240例患者的临床资料。结果 238例患者安全地完成腹腔镜胆囊切除，术中出血4例，均于镜下止血成功； 中转开腹2例。全组无胆管损伤，发生漏胆2例，经引流自愈。结论 联合后-前胆囊三角入路解剖胆囊管及胆囊动脉行腹腔镜胆囊切除是一种安全、容易掌握的手术方法。