ObjectiveTo explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. MethodsThe patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. ResultsA total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). ConclusionAccording to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.
ObjectiveTo investigate the clinical value of laparoscopic cholecystectomy following “A-B-D” approach applied in the operation of acute suppurative or gangrenous cholecystitis.MethodsWe sought out 45 patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the “A-B-D” approach in People’s Hospital of Leshan from Sep. 2019 to Dec. 2020 as the observation group (ABD observation group), and sought out 50 patients with the same diseases but treated by conventional laparoscopic cholecystectomy from Jun. 2018 to Aug. 2019 as the matched group (conventional matched group). We analyzed and compared the parameters related to safety and efficacy of the two groups retrospectively.ResultsA total of 95 patients were included, including 45 patients in the ABD observation group (26 cases of acute suppurative cholecystitis, 19 cases of acute gangrenous cholecystitis) and 50 patients in the conventional matched group (24 cases of acute suppurative cholecystitis, 26 cases of acute gangrenous cholecystitis). There were no significant differences in age, gender, body mass index, disease composition, gallbladder condition, and preoperative complications between the two groups (P>0.05). There was no bile duct injury case in the ABD observation group (0), while there were 4 cases (8.0%) in the conventional matched group, but the statistical results showed no statistical significance between the two groups (P=0.054). One case (2.2%) in the ABD observation group converted to laparotomy, which was significantly lower than the 10 cases (20.0%) in the conventional matched group, and the difference was statistically significant (P=0.017). In addition, there were no significant differences for other parameters including operative time, postoperative hospital stay, incidences of intraoperative bleeding and postoperative bleeding between the two groups (P>0.05).ConclusionsThe laparoscopic cholecystectomy following the “A-B-D” approach can help distinguish the anatomical structure of cystic duct and extrahepatic bile duct clearly, and it can help prevent biliary tract injury effectively and reduce the probability of conversion to laparotomy. It is worthy of clinical application and promotion, especially in the majority of county hospitals.
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.
Objective To explore the nursing effect of using Neiguan acupoint massage combined with chewing gum in patients undergoing day-case laparoscopic cholecystectomy. Methods A prospective study was conducted on patients who underwent day-case laparoscopic cholecystectomy in West China Hospital of Sichuan University between March 2023 and March 2024. The patients were randomly divided into the control group and the intervention group according to a random number table. The control group received routine care, while the intervention group received chewing gum and Neiguan acupoint massage intervention at the P6 acupoint in addition to routine care. The incidence of postoperative nausea and vomiting (PONV), pain scores, gastrointestinal function recovery time, medication use, and hospitalization related indicators were compared between the two groups of patients after surgery. Results A total of 298 patients were included. Among them, there were 163 cases in the control group and 135 cases in the intervention group. The incidence of PONV at 0.5 and 2 hours after surgery and the pain scores at 6, 12, and 24 hours after surgery in the intervention group were lower than those in the control group (P<0.05). The first bowel sounds recovery time, anal exhaust time, and eating time in the intervention group were shorter than those in the control group (P<0.05). Twenty-four hours after surgery, the usage rate of analgesic drugs (6.67% vs. 14.11%) and the usage rate of rescue antiemetic drugs (2.96% vs. 8.59%) in the intervention group were lower than those in the control group (P<0.05). There was no statistically significant difference in the delayed discharge rate or total cost between the two groups (P>0.05). The nursing satisfaction of the intervention group was higher than that of the control group (99.26% vs. 93.25%, P<0.05). Conclusions After the combination of Neiguan acupoint massage and chewing gum intervention in patients undergoingin day-case laparoscopic cholecystectomy, the PONV incidence and pain are significantly reduced, gastrointestinal functions recover faster, drug use rate is low, patient nursing satisfaction is high. This method can be promoted and applied.
ObjectiveTo evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) in same-day surgery model. MethodsThe patients who underwent LC at West China Tianfu Hospital of Sichuan University from November 1, 2023 to July 31, 2024, were retrospectively reviewed. The enrolled patients were divided into a same-day surgery LC group and a conventional inpatient LC group. In the same-day surgery group, a same-day discharge protocol was implemented, whereby patients were admitted, operated on, and discharged on the same day, with discharge required no later than 21:00 without an overnight stay. The conventional inpatient group was managed according to the conventional model. A comparison was carried out between the two groups concerning baseline characteristics, perioperative outcomes, surgery-related complications, postoperative urinary retention, total length of stay, hospitalization costs, and 30-day follow-up results. ResultsA total of 347 patients were included, comprising 164 in the same-day surgery LC group and 183 in the conventional inpatient LC group. No statistically significant differences (P > 0.05) were found between the two groups in the following terms: total anesthesia time, operative time, intraoperative blood loss, intraoperative fluid infusion, length of stay in the post-anesthesia care unit (PACU), fluid infusion in the PACU, placement of abdominal drains, visual analog scale pain score at discharge, rates of unplanned revisits due to changes in their disease conditionwithin 30 d after discharge, readmission rates, and the incidence of surgery-related complications. All complications in both groups were graded as Clavien-Dindo Ⅰ. The same-day surgery LC group demonstrated significantly lower preoperative fluid infusion, postoperative fluid infusion, total hospitalization costs, and a shorter total length of stay compared to the conventional inpatient LC group (P<0.05). Furthermore, the incidence of postoperative urinary retention was significantly lower in the same-day surgery LC group (P<0.05). ConclusionsThis study demonstrates that same-day surgery LC is a safe and feasible approach for appropriately selected patients. Its outcomes in key perioperative safety metrics are comparable to those of the conventional inpatient LC model, while it offers the significant advantages of effectively reducing the length of hospital stay, lowering medical costs, and decreasing the incidence of certain postoperative complications.
Objective To investigate clinical efficacy of laparoscopic cholecystectomy via left side approach for patients with acute cholecystitis. Methods One hundred and twenty patients with acute cholecystitis from January 2015 to May 2017 were collected. All of the patients were divided into observation group and control group according to the operative mode, with 60 cases in each group. In the observation group, the patients were treated by laparoscopic cholecystectomy via left side approach using the ligation-free technique to the main trunk of the cystic artery; in the control group, the patients were treated by the conventional laparoscopic cholecystectomy. After treatment, the operative situation, postoperative recovery, and incidence of postoperative complications were compared between these two groups. Results Compared with the control group, the operative time, first anal exhaust time, hospitalization stay, leukocytes recovery time, and coagulation function recovery time were shortened and the intraoperative bloods loss was reduced in the observation group, the differences were statistically significant (P<0.05). Furthermore, the overall postoperative complication incidence rate of the observation group was significantly lower than that of the control group (P<0.05). Conclusion For patients with acute cholecystitis, laparoscopic cholecystectomy via left side approach using ligation-free technique to main trunk of cystic artery is reliable and safe, which can effectively improve operative situation, shorten operative time, promote recovery of patient, and reduce incidence of postoperative complications.
ObjectiveTo investigate the socioeconomic benefits of enhanced recovery after surgery (ERAS) in perioperative period of selective laparoscopic cholecystectomy (LC) by prospective, randomized, controlled clinical study.MethodsA total of 90 patients were recruited in the Hetian Regional People’s Hospital from November 1, 2019 to December 25, 2019. PASS 11 software was used to calculate the sample size. They were grouped into an ERAS group and a tradition group by 1∶1 by random digital table. The patients in the ERAS and the tradition groups were treated with ERAS conception and traditional method respectively during the perioperative period. The postoperative hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation; the total hospitalization costs, intraoperative infusion, and postoperative total infusion; the intraoperative anesthesia intubation method, trocar layout, and operation time; the pain points of 6 h,12 h and 24 h after operation; the nausea and vomiting after operation; complications and re-hospitalization rate within 30 d after operation were compared between two groups.ResultsA total of 86 patients finally were included in the study, including 44 cases in the ERAS group and 42 cases in the tradition group. The basic data such as the gender, age, body mass index, etiology, blood routine, liver and kidney functions, etc. between the two groups were not statistically significant (P>0.05). Between the two groups, there were no significant differences in the intraoperative anesthesia intubation method, trocar layout, and operation time (P>0.05). Compared with the tradition group, the hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation were shorter (P<0.05); the total hospitalization costs, intraoperative infusion, and postoperative total infusion were less (P<0.05); the pain points of 6 h,12 h and 24 h after operation were lower (P<0.05); and the times of nausea and vomiting after operation were less (P<0.05) in the ERAS group. There were no complications such as the intraperitoneal bleeding, biliary leakage, and infection after operation, and no re-hospitalized patients within 30 d in both groups.ConclusionApplication of ERAS conception in selective LC perioperative period in Hetian Regional People’s Hospital of Xinjiang Uygur Autonomous Region cannot only shorten postoperative hospitalization time, reduce costs of hospitalization, help to overcome poverty, but also reduce occurrence of complications such as pain, nausea and vomiting, etc.
ObjectiveTo explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.MethodsA total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group (43 cases) and the jaundice-free control group (control group, 61 cases) according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored.ResultsThe ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group (P<0.05). In addition, the hospital stay in the jaundice group was shorter than that of the control group (P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications (included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups (P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index (CCI), and ratio of CCI≥20 (P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications (P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications (P>0.05).ConclusionPreoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.
ObjectiveTo compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.MethodsWe searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.ResultsA total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.ConclusionsBoth LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.
摘要:目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)后发生严重并发症的原因、治疗措施和经验教训。方法:分析 2007 年 8 月至2009 年 4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果:2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开(endoscopic sphincterotomy, EST)取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论:术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.