【摘要】 目的 比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）的费用，并进行卫生经济学评价。 方法 对2009年5-7月行胆囊择期手术的124例患者，随机分为LC组72例、OC组52例。比较两组的手术住院情况、直接和间接医疗成本、总成本。 结果 LC组的直接医疗成本、间接医疗成本、总成本分别为（4891±231）元、（338±76）元、（5229±387）元，均低于OC组的（5505±389）元、（540±82）元、（5945±412）元，两组间各项成本比较有统计学意义（Plt;0.001）。 结论 LC能缩短手术时间、住院时间，降低医疗费用，加快床位周转，提高卫生资源的利用效率。【Abstract】 Objective To compare the cost of the laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) and make the health economic evaluation. Methods From May to July 2009, 124 patients who underwent selective cholecystectomy were divided into LC group (72 cases), and OC group (52 cases). The hospitalizations, direct and indirect medical costs and the total costs were analyzed and evaluated. Results The direct, indirect health care costs and the total costs of the LC group were (4891±231), (338±76),(5229±387) yuan; and were lower than those of the OC group [(5505±389), (540±82), (5945±412) yuan]. The cost comparison between the two groups were significant different (Plt;0.001). Conclusion LC could shorten the operative time, hospitalization time, lower the medical cost, speed up the bed turnover and increase the efficiency in the use of health resource.
ObjectiveTo review the definition, incidence, risk factors, potential pathogenesis, biomarkers, and choice of follow-up treatment strategies of hyperprogressive disease (HPD).MethodDomestic and international literatures were collected to summarize the research progress of HPD in patients with malignant tumors who treated with immune checkpoint inhibitors (ICIs).ResultsThe research types of HPD were scattered, the sample size was limited, the definition standard was different, and there was lack of prospective validation studies. Therefore, the early warning assessment and molecular mechanism of HPD would become the next focus of the study of immunotherapy.ConclusionICIs can greatly improve the survival time of some patients with advanced malignant tumor, although some patients have HPD during treatment, but the incidence is relatively low.
Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
ObjectiveTo compare the effect of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients and non-elderly patients. MethodsThe clinical data of 185 cases of cholecystolithiasis combined with choledocholithiasis who treated in our hospital from September 2010 to November 2015 were analyzed retrospectively. Then the 185 cases of holecystolithiasis combined with choledocholithiasis were divided into elderly patients group (n=74) and the non-elderly patients group (n=111). The operative time, intraoperative blood loss, postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, incidence of complications, unplanned analgesia, stone-free rate, rate of conversion to laparotomy, recurrence of stone, and mortality were compared between the two groups. Results① Intraoperative and postoperative indexes. No significant difference was noted in operative time and intraoperative blood loss (P > 0.050), but the postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, and ratio of indwelling T tube of elderly patients group were all higher or longer than corresponding index of non-elderly patients group (P < 0.050). ② Postoperative complications and unplanned analgesia. There was no striking discrepancy in incidence of complications (including biliary leakage, peritonitis, haemorrhage, vomit, ectoralgia, and fever), and Clavien-Dindo grade (P > 0.050), except unplanned analgesia (P=0.007), the rate of unplanned analgesia in elderly patients group was higher than that of non-elderly patients group. ③Surgical effect. There was no significant difference in the stone-free rate, rate of conversion to laparotomy, and rate of recurrence of stone between the 2 groups (P > 0.050). ConclusionLC+LCBDE is also safe and effective in treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients, it's worthy to be expanded and be used broadly.
Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopiccommon bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/EST＋LC group （P＜0.05）. Conclusions Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies forcholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.
目的 比较腹腔镜胆道探查术后胆总管一期缝合与T管引流两种术式治疗胆囊结石合并胆管结石的疗效。方法 回顾性分析2011年4月至2012年5月期间笔者所在科室收治的因胆囊结石合并胆管结石接受腹腔镜胆囊切除＋胆道探查治疗的109例患者的临床资料，其中58例行T管引流，51例行一期胆总管缝合。比较2组患者的手术时间、住院时间、治疗费用、术后恢复正常生活时间以及手术并发症情况。结果 T管引流组术后发生胆瘘2例（3.4%），一期缝合组术后发生胆瘘1例（2.0%），其差异无统计学意义（P＞0.05）。2组患者的手术时间、住院时间及住院治疗费用的差异均无统计学意义（P＞0.05）。一期缝合组患者术后恢复正常生活时间为（7.2±1.1） d，短于T管引流组的（28.2±2.7）d（P=0.001）。结论 经腹腔镜胆道探查术后一期胆总管缝合是安全可行的，可缩短患者的康复时间，提高患者围手术期生活质量。
ObjectiveTo observe the effects of oral Xiaoyan Lidan tablets(XYLDT) on the bile composition(total bile acids, cholesterol, phospholipids) in patients with intrahepatic duct stones after common bile duct exploration(CBDE) with T tube drainage, to explore its possible preventive effects on stone recurrence. MethodsForty consecutive patients with intrahepatic bile duct stones who underwent CBDE with T tube drainage were randomly divided into experi mental group and control group. XYLDT were administrated at day 4 after surgery in experimental group(n=20), while none of medication were given in control group(n=20). 2 mL of bile was collected through T tube in both groups at day 1, 2, 3, 7, 14, and 21 postoperatively. Total bile acids(TBA), cholesterol(CHO), and phospholipids(PLIP) in bile were measured, and TBA/CHO ratio and PLIP/CHO ratio were calculated respectively. The results were statistical analyzed. ResultsThe demographic data in both groups including age, gender, height, weight, preoperative concomitant diseases, operative time, postoperative complications, hospital stays, serum total bilirubin, direct bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), and amylase were not significantly different(P > 0.05). The measurements of TBA, CHO, PLIP, and the ratio of TBA/CHO and PLIP/CHO in bile were not significant on day 1, 2, and 3 after surgery in both groups(P > 0.05). In experimental group, the TBA, CHO, and PLIP on day 7, 14, and 21 after surgery were significantly increased compared with the control group(P < 0.05). The ratio of TBA/CHO on day 7, 14, and 21 was 2.17±0.29, 2.29±0.44, and 2.59±0.58, the ratio of PLIP/CHO was 2.03±0.68, 2.84±0.64, and 2.86±0.77, respectively, which were also significantly increased compared with the control group(P < 0.05). ConclusionsOral XYLDT can increase the secretion of TBA, CHO, and PLIP, elevate the TBA/CHO and PLIP/CHO ratio, and change the bile composition which may increase the dissolution of cholesterol in the bile. Presumably, oral XYLDT may have preventive effects in the recurrence of intrahepatic bile duct stones.