围手术期护理干预对腹腔镜胆囊切除术疗效的影响

目的探讨围手术期实施护理干预措施,对腹腔镜胆囊切除术疗效的影响。方法腹腔镜胆囊切除术患者100例根据护理方法的不同随机分为护理干预和对照组各50例。对照组进行常规护理,护理干预在对照组的基础上采取一系列的术前、术中及术后的围手术期护理干预措施。观察比较两组腹腔镜胆囊切除术的疗效及并发症情况。结果护理干预组的手术时间、术中出血量及术后排气时间、术后住院时间均明显短于对照组（P〈0.05）。且护理干预组术后发生切口感染、出血以及胆漏、放射痛、肠粘连的发生率明显低于对照组（P〈0.05）。结论通过采取系列的围手术期护理干预措施,可以积极预防并发症的发生,缩短手术时间及住院时间,提高治疗效果。     

Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.

OBJECTIVE--To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis. DESIGN--Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations. SETTING--Two general surgical units in a teaching hospital. SUBJECTS--31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings. INTERVENTIONS--Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation. MAIN OUTCOME MEASURES--Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work. RESULTS--Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation. CONCLUSIONS--In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.     

Optimization of conscious sedation in plastic surgery.

The administration of conscious sedation by the plastic surgeon must be safe, efficient, and consistent. In the proper setting, with trained staff and appropriate backup, conscious sedation can allow optimal patient satisfaction with expedient recovery in addition to cost containment. The highly effective local anesthesia afforded by dilute, high-volume ("tumescent") infiltration extends the use of conscious sedation to cases previously performed under general anesthesia or deep sedation. The purpose of this analysis was to identify variables in conscious sedation that affect traditional outcome parameters in ambulatory surgery, particularly the duration of recovery and adverse events such as nausea and emesis. All perioperative and operative records of 300 consecutive patients having plastic surgical procedures under conscious sedation were carefully reviewed. Patients were ASA class I or II by requisite. Conscious sedation followed a standardized administration protocol, using incremental doses of two agents: midazolam (0.25 to 1 mg) and fentanyl (12.5 to 50 mcg). A subset of patients received preoperative oral sedation. Multivariate statistical analysis was conducted using SPSS 8.0 for Windows (SPSS Inc., Chicago, Ill.). Of the 300 patients, same-day discharge was intended for 281. Eight procedure categories were defined. No anesthetic complications occurred. As expected, recovery time was significantly correlated with the duration and type of procedure (p < 0.001) and the total dosage of both intraoperative sedative agents (p < 0.001). Interestingly, a negative correlation with advancing age existed (p < 0.001), likely reflecting the significantly higher intraoperative sedative dosing in younger patients (p < 0.001). When controlled for the effects of procedure duration and intraoperative sedative dosing, two other variables-use of preoperative oral sedation and postoperative nausea/emesis-significantly lengthened recovery time (p = 0.0001 for each). Fifteen unintended admissions occurred secondary to nausea, prolonged drowsiness, or pain control needs. Conscious sedation is an effective anesthetic choice for routine plastic surgical procedures, many of which would commonly be performed under general anesthesia. In our experience with a carefully structured and controlled conscious sedation protocol, the technique has proven to be safe and effective. This analysis of outcome parameters identified two important and potentially avoidable causes of recovery delay following conscious sedation-oral premedication and nausea/emesis. Nausea and emesis were particularly problematic in that they were responsible for 11 of 15 (73 percent) unintended admissions. Preoperative sedation is valuable in certain circumstances, and its use is not discouraged; however, its benefits must be weighed against its unwanted effects, which can include a prolongation of recovery.     

腹腔镜胆囊切除术中Rouviere沟引导定位的临床应用价值

目的:研究Rouviere沟引导定位对腹腔镜胆囊切除术的应用价值。方法:选择2010年7月至2014年10月在我院进行胆囊切除术的患者300例,根据手术方式不同将患者分为研究组和对照组,每组各150例。研究组患者在Rouviere沟引导下行腹腔镜胆囊切除术,对照组采用传统定位手术。观察并比较两组手术时间、并发症及手术效果。结果:研究组患者Rouviere沟分型为开放型89例(59.33%)、融合型32例(21.33%)、缺失型29例(19.33%),分型的性别构成存在统计学意义(P0.05);与对照组比较,研究组手术时间较短、并发症少和中转开腹率低,差异有统计学意义(P0.05)。两组术后未出现任何病例胆管损伤和手术死亡,手术后恢复较好。结论:Rouviere沟引导定位行腹腔镜胆囊切除术的临床效果较好,值得临床进一步推广应用。     

腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的临床观察

目的：探讨腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的应用价值。方法：回顾性分析2005年1月．2011年12月我院收治的210例65岁以上因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组（LC组）和剖腹胆囊切除术组（OC组）,分析和比较两组患者的手术时间、术后肠功能恢复时间及住院时间,术中出血、腹腔引流量和术后并发症的发生情况。结果：与OC组比较,LC组的手术时间、术后肠功能恢复时间及住院时间均显著缩短,差异有统计学意义（P〈0．01）;但两组之间术中出血、腹腔引流量和术后并发症的发生率差异均无统计学意义（P〉0．05）。LC组中转开腹10例,占7_35％;其中粘连严重导致胆囊三角解剖不清6例,无法控制的出血2例,结石嵌顿胆囊管2例。结论：老年急性胆囊炎患者在条件合适的情况下行腹腔镜胆囊切除术治疗有助于患者更快地恢复．具有较强的临床应用价值。     

腹腔镜与阴式子宫肌瘤剔除术临床疗效比较

目的观察比较腹腔镜与阴式子宫肌瘤剔除术的临床疗效。方法符合手术指征的90例子宫肌瘤患者分为腹腔镜组和阴式组（每组45例）,比较疗效。结果二组疗效相似,且术后无并发症发生,住院时问相当。阴式组手术时间、术中出血量、术后排气时间、住院费用明显低于腹腔镜组。结论与腹腔镜手术相比,经阴道手术直视下操作精确、快捷,价格低廉,适应症宽。但由于阴道空间狭窄,易损伤邻近脏器。临床应根据不同情况选择不同的手术方法,达到满意的治疗效果。     

Serum leptin levels and their response during laparoscopic and open cholecystectomy

We compared serum leptin responses during and after laparoscopic and open cholecystectomy, and assessed their correlation with the responses of inflammatory cytokines. Serum levels of leptin, interleukin-1alpha (IL-1alpha), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured by an enzyme-linked immunoassay in 31 patients who underwent laparoscopic cholecystectomy and in 24 patients who underwent open cholecystectomy. Serum samples were obtained preoperatively, at 10 and 30 min after the commencement of surgery, and at 6 and 24 h after the operation. The cumulative responses of leptin, IL-1alpha, IL-6 and TNF-alpha to surgery were calculated and the associations between them were evaluated. Serum leptin levels were significantly increased at 24 h after both procedures. The serum leptin concentration at this time point and the cumulative leptin response were significantly lower after laparoscopic cholecystectomy than after open cholecystectomy. Changes in serum IL-1alpha, TNF-alpha and IL-6 concentrations showed similar kinetics in both groups, with postoperative IL-6 levels being consistently lower in the laparoscopic cholecystectomy group. Cumulative IL-6 and TNF-alpha responses were significantly lower after laparoscopic cholecystectomy than after open cholecystectomy. The cumulative responses of leptin, IL-1alpha and IL-6 correlated significantly with each other. Leptin may be involved in the systemic inflammatory response to surgical injury, and the postoperative leptin elevation and cumulative leptin response are significantly lower after laparoscopic cholecystectomy than after open cholecystectomy.     

全身麻醉下达芬奇机器人手术在老年腹部手术中应用观察

目的:探究全身麻醉下达芬奇机器人在老年腹部手术中的应用效果。方法:选择2019年1月至2020年12月于我院接受腹部手术治疗的200例老年患者,将其按照术式分为研究组(100例)与对照组(100例),研究组选择达芬奇机器人开展手术,对照组选择常规腹腔镜手术,对比两组患者的手术时间、术中出血量、中转开腹率、术后排气时间、总住院费用、住院时间、术后患者自我效能及抑郁情况、术后疼痛度情况以及术后并发症发生情况。结果:(1)比较显示研究组患者的术中出血量、中转开腹率、术后排气时间均低于对照组(P<0.05),但其手术时间、总住院费用高于对照组(P<0.05);(2)术后研究组患者自我效能得分高于对照组,抑郁得分低于对照组(P<0.05);(3)术后24 h及48 h研究组疼痛得分均低于对照组(P<0.05);(4)研究组患者术后各类并发症发生率为4.00%,明显低于对照组的12.00%(P<0.05)。结论:全身麻醉下应用达芬奇机器人对老年患者实施腹部手术可行性较好,能够显著减小对患者的创伤,加快其术后康复,同时还能够降低其术后不良情绪和并发症发生,提高其自我效能,值得临床推广应用。     

心理护理对腹腔镜胆囊切除术患者焦虑心理的影响

目的:探讨心理护理对腹腔镜胆囊切除术患者焦虑心理的影响。方法:将84例腹腔镜手术患者随机分为2组:对照组23例,给予常规护理;心理护理组61例,给予常规护理+心理护理,其中文化程度<高中的患者34例,文化程度≥高中的患者27例。采用焦虑自评量表(SAS)评价焦虑状态,采用疼痛视觉模拟标尺评估患者疼痛情况,以及评估患者情绪情感、恐惧程度及对治疗满意度。结果:与对照组比较,心理护理组患者焦虑程度、恐惧程度、疼痛评分、显著下降(P<0.05);与文化程度<高中比较,文化程度≥高中的患者焦虑评分显著降低(P<0.05),情绪情感的评分显著增加(P<0.05);术后第1-2天疼痛评分无显著差异(P>0.05),术后第3天疼痛评分有显著差异(P<0.05);心理护理组的满意度明显升高(P<0.05)。结论:腹腔镜手术患者存在明显的焦虑、恐惧症状,心理护理干预能有效缓解患者焦虑心理,减轻疼痛程度,减少疼痛时间,提高患者对医疗服务满意度,可有效提高临床护理质量与效率。     

单孔和四孔腹腔镜胆囊切除术的临床疗效对比分析

摘要 目的：探讨单孔和四孔腹腔镜胆囊切除术的疗效差异。方法：回顾性分析上海交通大学医学院附属仁济医院胆胰外科2018年6月至2019年8月期间施行单孔（单孔组）和四孔腹腔镜胆囊切除术（四孔组）的临床资料,包括手术时间、腹腔引流管留置率、手术方案转变率、手术出血量、术后并发症率（胆漏、出血、伤口感染）、住院时间、住院费用、术后24 h镇痛药物使用率和术后满意度等。结果：单孔组手术时间显著长于四孔组[(42.48±6.66)min Vs (32.18±7.08)min],单孔组腹腔引流管留置率显著低于四孔组（1.67% Vs 21.67%）,差异均有统计学意义（P<0.05）;单孔组的住院时间短于四孔组[(2.22±0.65)天 Vs (2.71±0.57)天],单孔组住院费用高于四孔组[(2.19±0.17)万元Vs (1.81±0.14)万元],单孔组术后24 h镇痛药物使用率低于四孔组（4.17% Vs 16.67%）,术后满意度评分单孔组较四孔组更高[(4.68±0.64)分 Vs (4.47±0.68)分],差异均有统计学意义（P<0.05）;单孔组的手术出血量、手术方案转变率以及术后并发症与四孔组比较没有差异（P>0.05）。结论：单孔腹腔镜胆囊切除术的术后疼痛轻,恢复快,手术安全性与传统四孔腹腔镜胆囊切除术相比无明显差异,同时单孔腹腔镜胆囊切除术满意度更高,值得临床推广。     

老年骨科手术患者麻醉后认知功能障碍的多因素分析及模型预测初步研究

摘要 目的：探讨分析影响老年骨科手术患者麻醉后的认知功能障碍的因素并建立预测模型。方法：将2016年1月至2019年1月于我院骨科行手术的227例老年患者根据术后认知功能障碍评分分为认知障碍组及无障碍组,比较两组一般资料及手术方式、麻醉方式等手术相关因素,使用多因素Logistic回归模型分析影响术后认知功能障碍发生的因素,使用R软件建立出现认知功能障碍的列线图预测模型,并验证其效能。结果：术后共有65例患者出现认知功能障碍,认知障碍组患者的年龄、行全麻的患者比例、术中失血量、手术时间及出现术后并发症患者比例均明显高于无障碍组,而术中血压及应用超前镇痛患者比例均明显低于无障碍组（均P＜0.05）;而两组患者性别、BMI及手术部位等指标则无明显差异（均P＞0.05）;多因素Logistic回归分析示高龄、全麻、术中失血量过多、过长手术时间及术后出现并发症均是老年骨科手术患者术后出现认知障碍的独立危险因素（OR=1.077,3.796,3.826,1.712,6.937;均P＜0.05）;而术中高收缩压、舒张压及术前给予超前镇痛是术后出现认知功能障碍的保护因素（OR=0.953,0.913,0.333;均P＜0.05）;列线图预测认知功能障碍发生的一致性指数（C-index）为0.904（95%Cl 0.862~0.961）。结论：高龄、全麻、无超前镇痛、手术时间过长、术中失血量过多、术中低血压及术后出现并发症是出现术后认知功能障碍的危险因素,基于此构建的列线图可有效对术后认知功能障碍进行预测,具有较好的临床应用价值。     

经脐单孔腹腔镜辅助整形术治疗急性胆囊炎的临床效果

目的:探讨单孔腹腔镜辅助整形术(TUES)对急性胆囊炎患者腹壁美观及其肝功能的影响。方法:选取我院急性胆囊炎择期手术患者130例,随机分为观察组和对照组。观察组采用经脐单孔腹腔镜胆囊切除术联合整形术,对照组采用三孔腹腔镜胆囊切除术。观察并比较两组手术时间、术后疼痛评分、切口满意度及肝功能指标的变化情况。结果:与对照组比较,观察组患者手术时间长,术后疼痛评分低,患者对切口美观满意度高,差异具有统计学意义(P0.05)。两组住院日无显著差异(P0.05)。两组患者术前ALT、AST和ALP水平无显著差异(P0.05)。两组患者术后ALT、AST和ALP水平均高于术前,组内比较差异具有统计学意义(P0.05)。观察组患者术后ALT、AST和ALP水平低于对照组,组间比较差异具有统计学意义(P0.05)。结论:单孔腹腔镜辅助整形术能够改善急性胆囊炎患者病情,提高腹壁美观效果,而且对肝功能影响较小,值得临床推广。     

腹腔镜胆囊手术和开腹胆囊手术对术后肠黏连的影响比较

目的:比较腹腔镜胆囊手术和开腹胆囊手术对于术后肠黏连的影响,对比两种手术的有效性和安全性。方法:回顾选取在我院接受胆囊手术治疗的196例病患,根据术式分成开腹组和腹腔组,每组均为98例患者,对比分析组间手术指标以及术后出现肠黏连的情况,同时观察手术前后患者消化道生存质量变化。结果:腹腔镜组手术耗时(123.57±4.65 min)长于开腹组,术中出血(27.52±5.69 mL)、胃肠功能恢复用时(18.03±3.51 h)、术后住院时间(4.51±1.03)、肠黏连发生率(10.20%)少于开腹组,(P0.05);两组术前GLQI评分相仿(P0.05),术后GLQI评分显著高于组内术前(P0.05),且腹腔镜组术后GLQI评分显著高于开腹组(P0.05)。结论:与开腹手术相比,腹腔镜胆囊手术不仅手术创伤小、术后恢复时间短,而且术后肠粘连发生率低,值得推广。     

Efficacy of the pain pump catheter in immediate autologous breast reconstruction

The purpose of the investigation was to evaluate the efficacy of a slow bupivacaine infusion at postoperative surgical sites in immediate breast reconstruction patients. This prospective study included 16 patients who underwent autologous breast reconstruction with a latissimus dorsi pedicled flap immediately after mastectomy. A two-site infusion kit with dual split-flow catheters was secured at the operative sites before skin closure. A spring-loaded disposable pump then infused 0.25% bupivacaine at a rate of 2.08 cc per catheter per hour for 48 continuous hours. Patient pain levels, nausea/emesis, and oral and intravenous narcotic use were then recorded at 12-hour intervals. Medication use was converted to pain units for results comparison (one pain unit was defined as the equivalent of 10 mg of intravenous morphine). A retrospective control group comprised 16 consecutive patients from December of 1999 to October of 2002 who underwent the same surgery by the same surgeon using oral and intravenous pain medications. The experimental group demonstrated a more than fivefold decrease in the use of oral and intravenous pain medications compared with the historical controls (6.7 versus 1.7 pain units) (p < 0.001). The overall pain experienced by the catheter patients was nearly twofold less than the pain experienced by those without the catheter (1.8 versus 3.4 on the visual analog pain scale) (p < 0.017). Twenty-eight percent of the experimental group experienced nausea/emesis compared with 61 percent in the control group. No complications occurred with the use of the pain pump catheter. A 48-hour infusion of 0.25% bupivacaine significantly decreases the need for postoperative narcotics and the over-all pain experience in immediate breast reconstruction patients. This effective form of pain control may alleviate patient concerns of postoperative pain and may safely downstage many plastic surgery procedures, such as immediate breast reconstruction, and many cosmetic procedures to same-day status when the primary indication for admission is pain management.     

The prevention of emesis in plastic surgery: a randomized,prospective study

Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. Its utility in cases performed under conscious sedation has not been determined. The purpose of this study was (1) to test the ability of prophylactic ondansetron to prevent postoperative nausea and vomiting in plastic surgery cases performed under conscious sedation, and (2) to determine relative risk factors for postoperative nausea and vomiting and a selection policy for the administration of antiemetic prophylaxis. This was a prospective, randomized, double-blind study. One hundred twenty patients were enrolled after giving informed consent. Patients received a single dose of either placebo or ondansetron (4 mg intravenously) before administration of sedation. Sedation administration followed a standardized institutional protocol, using midazolam and fentanyl. Data were recorded from a series of three questionnaires: preoperatively, immediately postoperatively, and at the time of the first office return. Data were confirmed by means of telephone interview, chart analysis, and nursing documentation. Multivariate analysis was conducted. Nausea and emesis occurred with an overall frequency of 33 percent and 22 percent, respectively. Postoperative nausea and vomiting was associated with statistically longer recovery periods. The incidence of emesis was statistically higher among women, among those undergoing facial rejuvenation, and among those with a history of opioid-induced emesis or postoperative nausea and vomiting following a previous operation (p < 0.05). The incidence of postoperative nausea and vomiting paralleled increases in case duration; the incidence of emesis was zero in cases less than 90 minutes in duration. Ondansetron significantly reduced the incidence of emesis overall (placebo, 30 percent; ondansetron, 13 percent; p < 0.05). Postoperative perception of nausea was significantly lower among those who had received ondansetron (p < 0.05). These results confirm the efficacy of ondansetron for the prevention of postoperative nausea and vomiting in plastic surgery cases under conscious sedation. In those who are at increased risk, prophylaxis should be considered. Such risks include female gender, facial rejuvenation procedures, and a patient history of opioid-induced emesis or postoperative nausea and vomiting following a prior operation. The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients.     

腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素分析

目的:探讨影响腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素。方法:回顾性分析行腹腔镜腹股沟疝修补术的6632例患者的临床资料,将凝血病、抗凝治疗或抗血小板治疗的829例患者归入风险组(n=829),其他患者归为对照组(n=5803),收集并比较二组患者的手术方式、年龄、性别、美国麻醉师协会(ASA)分级、疝缺损面积(I-III级)、一期手术与二次手术等患者资料,进行一年随访;采用多变量分析影响患者继发性出血及并发症所致二次手术的相关因素。结果:风险组的术后出血发生率显著高于对照组(4.22%vs 1.26%,P0.001),所有患者术后出血发生率为1.63%。影响术后继发性出血的其它负面因素有:开放式腹股沟疝术式、年龄增加、较高ASA分级、二次手术、男性和较大的疝缺损。风险组与并发症相关的二次手术发生率显著高于对照组(2.65%vs 1.14%,P0.001),所有患者与并发症相关的二次手术发生率为1.32%。影响患者并发症所致二次手术负面因素有:双侧手术、较高ASA分级、凝血病与抗凝治疗和抗血小板治疗、高龄,保护因素包括:较小的疝缺损面积与腹腔镜手术式。结论:行腹腔镜腹股沟疝手术患者术后出血性及并发症相关的二次手术的风险小于行开放术式患者。     

胃复安与雷莫司琼对全麻腹腔镜胆囊摘除术患者呕吐及躁动的影响

目的:探讨胃复安与雷莫司琼对全麻下腹腔镜胆囊摘除术患者术后呕吐及躁动的影响。方法:选取我院收治的全麻下腹腔镜胆囊摘除术者86例,根据术后治疗方法不同,分为两组,其中对照组予以雷莫司琼治疗,实验组在对照组基础上予以胃复安治疗。观察并比较两组患者的临床疗效、呕吐、躁动及不良反应发生情况。结果:与对照组比较,实验组临床疗效明显,差异具有统计学意义(P0.05);实验组患者呕吐次数明显低于对照组,差异具有统计学意义(P0.05);实验组患者躁动明显改善,差异具有统计学意义(P0.05);实验组不良反应发生率低于对照组,差异具有统计学意义(P0.05)。结论:胃复安与雷莫司琼能够有效治疗全麻下腹腔镜胆囊摘除术患者术后呕吐及躁动情况,提高临床疗效。     

The evaluation of skin disinfection efficacy and its influence on prevalence of surgical site infections in patients subjected to laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is "the method of choice" in the treatment of cholelithiasis and its' complications. LC is not devoid of complications, among others, surgical site infection (SSI) but as a result of minimalisation of surgical trauma and immunosuppression after surgery, percentage of SSI is lower than after conventional cholecystectomy. Skin disinfection carried out before operation is thought to minimalise risk of infective complications after LC. 150 patients who had laparoscopic cholecystectomy carried out, were included in prospective study. Efficacy of skin disinfection was based on microbiological assessment including swabs from the umbiliculus before and after skin disinfection, and samples of exsudate or discharge from surgical site (if any). There were 133 (88.6%) patients with positive result of the umbilical swab before the disinfection of the skin, whereas 26 (17.3%) patients had bacteria isolated from the umbilical swab after the disinfection. Among these 26 patients in 19 (73.1%) cases the same species of bacteria were isolated before and after skin disinfection. Among 19 patients with inefficient skin dissinfection in 2 cases we observed SSI. In one of them the same strains of bacteria were isolated from umbilical swab and surgical site. Analysis of drug sensitivity of these isolates showed strict correlation. There were 16 cases of SSI in the whole group and it's rate was 10,6%. Skin disinfection before LC is not fully efficient. Inefficiency of skin disinfection does not increase risk of SSI. Skin dissinfection reduce microbial flora but does not protect from SSI provoked by these microbials.     

一步法腹腔镜胆囊切术联合胆总管探查取石术在慢性胆囊炎胆囊结石合并胆总管结石治疗中的有效性及安全性探究

摘要 目的：探究一步法腹腔镜胆囊切术（LC）联合胆总管探查取石术（LCBDE）在慢性胆囊炎胆囊结石合并胆总管结石治疗中的有效性及安全性。方法：纳入2018年6月至2021年9月行一步法LC+LCBDE治疗的慢性胆囊炎胆囊结石合并胆总管结石患者49例（观察组）,并以行开腹胆囊切除术+胆总管切开取石治疗的慢性胆囊炎胆囊结石合并胆总管结石患者43例为对照组,比较两组手术疗效及手术相关指标;观察患者手术前后肝功能指标、胆红素水平及免疫功能变化,并统计患者术后并发症发生情况。结果：观察组及对照组手术成功率均为100%,两组对比无明显差异（P>0.05）;观察组手术时间、肠鸣音恢复时间、肛门恢复排气时间及住院时间短于对照组,术中出血量少于对照组（P<0.05）;观察组术后丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（GGT）、天冬氨酸氨基转移酶（AST）及总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）水平均低于对照组（P<0.05）;观察组术后7 d的免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）水平均高于对照组（P<0.05）;观察组术后并发症发生率低于对照组（P<0.05）。结论：一步法LC+LCBDE治疗慢性胆囊炎胆囊结石合并胆总管结石的成功率高,可促进术后胃肠功能及肝功能恢复,提高机体免疫力,并能降低术后并发症发生率。     

32例腹腔镜胆囊切除术意外胆囊癌的临床诊治

目的:分析腹腔镜胆囊切除术中或术后发现意外胆囊癌的临床特点,探讨其诊治措施。方法:回顾性分析2008年1月~2012年12月在我院行腹腔镜胆囊切除术治疗发现的意外胆囊癌患者共计32例的临床资料和随访结果。结果:24例患者经术中快速冷冻病理证实,其中12例中转开腹行胆囊癌根治术;8例患者经术后病理证实,6例行二次开腹手术。Nevin I期4例,Nevin II期20例,Nevin III期5例,Nevin IV期2例,Nevin V期1例。32例患者均顺利出院,住院时间6~24d,平均住院时间(13.8±8.1)d。32例中有30例获得随访,2例失访,随访时间2~49个月,平均(24.2±14.6)个月。生存23例,死亡7例,分别死于术后2、3、5、12、14、18和32个月。术后有5例患者出现并发症,2例胆囊积液,2例切口感染和1例胆瘘,经对症治疗后好转。结论:加强对胆囊癌的警惕与认识,腹腔镜胆囊切除术中或术后发现意外胆囊癌后应根据具体情况,选择最佳手术方式治疗,提高根治切除率,延长患者生存期。