【摘要】 目的 探讨高原地区腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）患者的特点，以便更好地进行围手术期处理。 方法 对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者（高原组）367例和非高原地区患者（非高原地区组）167例的一般资料、术前诊断、合并症情况进行回顾性分析，两组患者性别、年龄及病程比较，差异无统计学意义（Pgt;0.05），有可比性。两组患者诊断均以胆囊结石为主，其次为胆囊息肉，诊断构成比较，差异无统计学意义（Pgt;0.05）；两组患者合并症比较，高原组患者高血压、冠心病、血红蛋白增多症及窦性心动过缓的发生率高于非高原地区组（Plt;0.05）；肺部疾病、肝硬化、糖尿病及脑梗死的发生率两组患者比较差异无统计学意义（Pgt;0.05）。两组患者均采用常规LC进行治疗，对两组患者术后临床结果、并发症等进行统计学分析。 结果 高原组患者手术中转开腹率（7.1%）高于非高原地区组（2.4%）患者（Plt;0.05）；高原组患者较非高原地区组患者住院时间长、手术时间长、术中出血量多（Plt;0.05）；术后并发症比较差异无统计学意义（Pgt;0.05）。 结论 高原地区LC患者宜及时中转开腹，其围手术期处理得当将有助于减少术后并发症的发生。【Abstract】 Objective To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management. Methods We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done. Results The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05). Conclusions Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.
目的探讨自制双孔缝合针在腹腔镜下治疗小儿疝囊高位结扎术中的临床价值。方法对2008年5月至2010年5月期间在成都市第五人民医院收治的237例腹股沟斜疝儿童应用自制双孔缝合针在腹腔镜下行疝囊高位结扎术治疗的临床资料进行回顾性分析。结果237例均在腹腔镜下完成疝囊高位结扎术。单侧手术181例，时间5～7 min,平均5.8 min; 双侧56例，手术时间7～12 min，平均9.1 min。术后均无局部血肿、阴囊水肿、阴囊积气、切口感染、皮下异物感等并发症发生。术后随访时间为8～24个月（平均18.5个月），21例失访，未见疝复发及术侧睾丸发育异常。结论在腹腔镜下运用自制双孔缝合针对小儿疝囊进行高位结扎具有手术时间短、局部创伤小、术后并发症少、术后疼痛轻、操作简单等优点，在临床上具有推广价值。
Objective To summarize the experience of laparoscopic ventriculo-peritoneal shunt for treating patients with hydrocephalus. Methods Twenty-two cases with hydrocephalus were treated with laparoscopic ventriculo-peritoneal shunt.The drainage-tube was put into the right liver-diaphragm interspace in 9 patients and inserted into the pelvic kidney in the others. Postoperative complications, ameliorating conditions of intracranial hypertension and recovery conditions of these patients were observed. Results All the operations were succeeded and the patients got amelioration of intracranial hypertension.No complication correlating with laparoscopic surgery occured. Conclusion Laparoscopic ventriculo-peritoneal shunt have the advantages of less invasive,better intra-abdominal view and more rapid recovery than conventional laparotomy. It’s a safe and feasible method which is worth of wide using.
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。