目的 探讨上腹部手术后腹腔镜胆囊切除术(LC)的可能性及手术方法与技巧。方法 回顾性分析我院2005～2009年期间对有上腹部手术史行LC的23例患者的临床资料。结果 23例患者中慢性结石性胆囊炎18例，胆囊息肉5例。既往均有上腹部手术史，其中胃大部切除术后19例,胃平滑肌瘤切除术后2例,脾破裂修补术后2例。采用闭合法穿刺建立气腹，分离粘连，暴露胆囊全貌及Calot三角，顺行或逆行切除胆囊。23例中LC成功21例; 因粘连致密，胆囊管无法辨认，中转开腹2例。手术时间45～140 min，平均67 min。全组无明显出血、内脏损伤、胆管损伤、胆汁漏等并发症发生。结论 部分上腹部手术后胆囊良性疾病行LC术可行。
Objective To evaluate the cl inical effect of local autogenous bone chips extended with allogeneic bone grafts in the posterolateral lumbar fusion. Methods From March 2005 to April 2007, 22 cases which underwent posterolaterallumbar fusion with allograft bone mixed with local autograft bone were analyzed retrospectively. The postoperative temperature, drainage flow and heal ing time of the incision were analyzed; postoperative lumbar pain was evaluated by visual analog scale (VAS) and JOA score; the postoperative efficacy was assessed by MacNab criteria and Oswestry disabil ity index (ODI); the fusion rate was defined by Jorgenson fusion criteria. Results All cases were followed up for 17-35 months with an average of 21 months, the wound all healed by first intention; no red swell ing, exudation and infection occurred. The excellent and good rate was 81.8% for JOA score (excellent in 4 cases, good in 14 cases, fair in 4 cases), 77.3% for MacNab criteria (excellent in 4 cases, good in 13 cases, fair in 5 cases) and 90.9% for ODI index (excellent in 3 cases, good in 17 cases, fair in 2 cases). The postoperative X-ray fusion rate within 1 year was 90.9%. Conclusion Allograft bone mixed with local autograft bone can achieve good efficacy and fusion rate in posterolateral lumbar fusion.