目的评估PK刀在腹腔镜阑尾切除（LA）中的应用价值。方法回顾性分析广西桂东人民医院2009年6月至2010年6月期间68例行LA患者的临床资料，其中PK刀组34例，高频电凝钩组34例，比较2组患者的手术时间、术中出血量、术后肠道功能恢复时间及住院时间。结果所有手术均获成功，无中转开腹及术后大出血等并发症发生，PK刀组较高频电凝钩组的手术时间明显缩短(Plt;0.05)、术中出血量明显减少(Plt;0.05)及术后肠道功能恢复时间更快(Plt;0.05)； 住院时间2组间差异无统计学意义(Pgt;0.05)。结论PK刀具有凝固均匀、完全、热损伤少、止血效果好、操作简单等优点，可选择性地应用于LA。
Objective To evaluate the clinical value of ureteroscope in cholelithiasis treated by laparoscopic surgery. Methods The clinical data of 36 patients admitted because of hepatolithus with ureteroscope combination in laparoscopic surgery from February 2007 to September 2009 in Guidong People’s Hospital of Guangxi were analyzed retrospectively. Results In 33 cases, stones were removed once by ureteroscope in laparoscopic surgery with residual stones (in 3 cases residual stone were removed secondarily through T tube) and the other 3 cases were transferred to laparotomy forcedly due to bleeding of biliary duct and vessels of porta hepatis and tearing of bile duct. During operation, blood loss was 30-280 (94.51±54.70) ml; operation time was 110-260 (147.22±48.45) min; recovery time of bowel movement was 1-3 (2.03±0.76) d; postoperative hospitalization time was 6-13 (7.12±1.65) d (some discharged with T tube); the time of patients of T tubes pulled out was 28-45 (38.92±6.52) d. Bile leakage happened in 1 case and infection of biliary tract in 1 case, no complications such as biliary stricture or bile duct bleeding were found after operation. Conclusions Treatment of intrahepatic bile duct or a single extra-hepatic sand-like stones with ureteroscopy usage in laparoscopic surgery is feasible and less invasive. It is a minimally invasive treatment for intra- or extra-hepatic stones due to rapidly postoperative rehabilitation.
目的 探讨腹腔镜胆囊切除术（LC）中因胆囊破裂致腹腔残留胆石对术后机体的影响。方法 2001年3月至2009年8月期间广西桂东人民医院对750例胆囊结石患者进行了LC，术中穿破胆囊30例（4.0%），其中术后发现腹腔内残留胆石者10例（1.3%）。回顾性分析该10例患者的临床和随访资料。结果 本组患者住院时间2～7 d，平均4 d。随访2～36个月（平均10个月），CT、X线或B超检查8例患者腹腔仍残存明显胆石，其中1例合并有腹腔脓肿，给予抗炎治疗后症状消失（脓肿较小）； 另2例腹腔残存胆石消失。10例患者均无慢性腹痛、表皮窦道形成、肠梗阻、腹腔肿瘤等并发症。随访期间10例患者肝功能及T细胞水平与术后第2天比较，差异无统计学意义（P＞0.05），WBC水平则明显降低（P＜0.05）。结论 LC中如果无法寻找到遗留于腹腔的微小胆石时，只要常规腹腔冲洗，术后预防性应用抗生素，少数残留于腹腔的小胆石对术后机体无严重不良影响。