Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007， 113 patients including chronic gallstone cholecystitis （n=55）, inactive cholecystolithiasis （n=46） and gallbladder polyps （n=12） were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation， 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC， 3 months and 6 months after LC were (5±2) mm, (8±2) mm and (6±2) mm respectively. And in chronic gallstone cholecystitis patients they were (5±2) mm, (9±2) mm and (6±2) mm respectively， in inactive gallstone cholelithiasis patients they were (5±2) mm, (8±2) mm and (6±2) mm respectively， and in gallbladder polyps ones they were (5±2) mm, (7±2) mm and (5±2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.
目的 探讨联合后-前胆囊三角入路在腹腔镜胆囊切除中的应用价值。方法 回顾性分析我院2007年1月至2010年1月期间经联合后-前胆囊三角入路解剖胆囊管及胆囊动脉行腹腔镜胆囊切除的240例患者的临床资料。结果 238例患者安全地完成腹腔镜胆囊切除，术中出血4例，均于镜下止血成功； 中转开腹2例。全组无胆管损伤，发生漏胆2例，经引流自愈。结论 联合后-前胆囊三角入路解剖胆囊管及胆囊动脉行腹腔镜胆囊切除是一种安全、容易掌握的手术方法。
目的 探讨内镜逆行胰胆管造影(ERCP)检查及内镜治疗在腹腔镜胆囊切除(LC)术前、术后的应用价值。 方法 对61例拟行LC的患者术前或术后行ERCP检查，发现异常再行内镜治疗。结果 LC术前行ERCP者42例中39例显影，其中37例伴有其他胆管疾病，占94.9%。术后行ERCP者19例均显影，总的插管成功率为95.1%。LC术前或术后42例行EST治疗，4例行EPBD，2例行ERBD，15例行ENBD，另4例在行ERCP检查后改开腹手术，取石成功率为92.9%。结论 诊治性ERCP在LC前、后的应用，对进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
The article reports 300 cases of laparoscopic cholecystectomy performed in Chengdu General Hospital of P.L.A. from October 1992 to August 1993. 16 of 300 were converted to open procedure. The number of postoperative complication cases was 12(4%).
目的 比较腹腔镜胆囊切除术（LC）与小切口胆囊切除术（MC）在老年患者中的临床效果，以指导临床选择应用。 方法 回顾性分析笔者所在医院2010年7月至2013年7月期间行LC（LC组，n=109）及MC（MC组，n=111）的老年患者的临床资料，比较2组术中和术后相关指标的差异。 结果 LC组和MC组患者的手术时间〔（45.72±6.14）min比（40.67±6.02）min〕、术中出血量〔（10.18±3.31）mL比（11.13±2.93）mL〕、住院时间〔（9±5）d比（10±5）d〕及总并发症发生率〔28.4%（31/109）比31.5%（35/111）〕比较差异均无统计学意义（P＞0.05）；但LC组患者的术后疼痛程度轻、胃肠道功能恢复时间短〔（46.3±10.5）h比（71.4±9.8）h〕、住院费用较高〔（8 010±450）元比（4 800±680）元〕、切口感染发生率较低〔0（0）比15.3%（17/111）〕、肺部感染发生率较高〔17.4%（19/109）比9.9%（11/111）〕，P＜0.05。 结论 LC对老年胆囊结石或胆囊炎患者具有更好的临床效果；但对心肺功能异常者，尤其是不能耐受全麻和气腹的患者选择MC更为合适，所以临床上应视患者具体情况加以选择。
目的 探讨腹腔镜胆囊切除术（LC） 中采用提胆囊壶腹、看Rouviere沟、胆囊后三角入路法切除胆囊，对成功完成LC和预防胆管、血管损伤的临床意义。方法 2009年7月至2011年12月期间应用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法（研究组） 切除胆囊112例，同期常规方法（对照组） 行LC 55例，比较2组的临床疗效。结果 2组一般临床资料比较差异无统计学意义（P＞0.05），具有可比性。研究组112例成功完成了LC，无中转开腹及并发症发生。对照组55例LC发生并发症3例，其中2例胆管损伤及1例左肝动脉损伤。研究组的并发症发生率明显低于对照组〔0 （0/112）比5.45% （3/55），P＜0.05〕，研究组和对照组间术中出血量、手术时间、住院时间及中转开腹率差异均无统计学意义 〔术中出血量： （8.95±3.95） mL比（8.09±3.91） mL，P=0.189；手术时间：（84.72±37.15） min比（77.05±37.22） min，P=0.212；住院时间：（6.40±2.39） d比（7.02±3.41） d，P=0.178〕。结论 在LC中，采用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法，相对容易精准解剖壶腹部与胆囊管移行区，完整显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉，既是成功完成LC的保证，又可有效避免术中胆管和血管的损伤。