瘘

Results Among 89 cases,68 cases underwent cholecystectomy(6 cases bile duct drainage),and 14 cases subtotal cholecystectomy,cholecystostomy in 7 cases;death occurred in one case.

结果 89例中行胆囊切除术68例(胆总管T管引流术6例)，胆囊大部切除术14例，胆囊造瘘术7例。治愈88例，死亡1例。

We performed cholecystectomy in 10 cases, cholecystectomy and choledochotomy for common bile duct exploration and stone removal and T-tube drainage in 2, partial cholecystectomy in 3, cholecystostomy in 1. Pathological examination showed that it was AGC in all the patients.

该组行胆囊切除术10例，胆囊切除+胆总管切开取石+T管引流术2例，胆囊大部切除术3例，胆囊造瘘术1例，术后病理报告均为急性坏疽性胆囊炎。

For children with more organ inflammatory edema and adherence and in a bad overall condition, the first-time operation of cholecystostomy is more reasonable.

初次手术行胆囊造瘘术对于胆总管囊肿自发穿孔后腹腔炎性反应水肿明显、黏连重、状态差的患儿是一种更合理的术式选择。

Results Preoperative diagnostic rate was53.6%,and operative resection rate was71.4%,simple cholecystectomy in6cases,cholecystectomy and exploration of the biliary passage in4cases,gallbladder and regional lymphadonectomy in2cases,gallbladder and liver wedge resection and regional lymphadonectomy in6cases,gallblad-der and liver wedge resection and regional lymphadonectomy and right hemicolectomy in1case,and gallbladder and liver wedge resection and regional lymphadonectomy and subtotal gastrectomy and right hemicolectomy in1case.Unre-sectable rate were28.6%,gastro-jejunostomy in2cases,cholecystostomy in1case.Laparotomy exploration only in5cases.

结果 术前确诊率仅为53.6%（15/28），手术切除率为71.4%（20/28），单纯胆囊切除术6例（占21.4%），胆囊切除+总胆管探查4例（占14.3%），胆囊切除+区域淋巴结清扫2例（占7.1%），胆囊+肝楔状切除+区域淋巴结清扫6例（占21.4%），胆囊+肝楔状切除+区域淋巴结清扫+右半结肠切除1例（占3.6%），胆囊+肝楔状切除+区域淋巴结清扫+胃大部切除+右半结肠切除1例（占3.6%），未切除率为28.6%，胃-空肠吻合术2例（占7.1%），胆囊造瘘1例（占3.6%），仅做剖腹探查术5例（占17.9%）。

Results: Among 80 cases of ACST, 76 cases were successfully implemented LC, gallbladder puncture and decompression choledocholithotomy T-tube drainage were performed in 11 cases, choledocholithotomy T-tube drainage in 15 cases, common bile duct gall bladder fistula Toishi T-tube drainage in 14 cases, gallbladder removal choledocholithotomy T-tube drainage in 36 cases, operative time 15-120 min, bleeding 10-80 ml; 4 cases transitted laparotomy, 1 case of gallbladder and surrounding tissue adhesion serious, ampulla signs disappear, and the hepatoduodenal ligament ill-defined, 2 cases of gallbladder contraction deep within the liver, gallbladder triangle scar adhesions, and 1 case of duct stone impaction and severe adhesions; postoperative hospital stay was 8-11 d, all were well recovered; pathological diagnosis, acute cholecystitis in 41 cases （51.2％）, acute suppurative cholecystitis in 24 cases （30.0％）, acute gangrenous cholecystitis in 15 cases （18.8％）.

结果：重症急性胆囊炎80例，76例成功实施LC，其中，胆囊穿刺减压胆总管切开取石T管引流11例，胆总管切开取石T管引流15例，胆囊造瘘胆总管切开取石T管引流14例，胆囊切除胆总管切开取石T管引流36例，手术时间15～120 min，术中出血10～85 ml；4例中转开腹，其中，1例胆囊与周围组织粘连严重，壶腹部标志消失，与肝十二指肠韧带界限不清，2例胆囊萎缩深陷肝脏内，胆囊三角区瘢痕粘连，1例胆囊管结石嵌顿且严重粘连，术后住院时间8～11 d，术后恢复均良好，治愈出院；80例术后病理诊断，急性单纯性胆囊炎41例（51.2％），急性化脓性胆囊炎24例（30.0％），急性坏疽性胆囊炎15例（18.8％）。

The operation consisted of cholecystectomy,choledochostomy,jejunostomy and great omentum resection; the pancreas was not operated.All of the patients survived.

行胆囊切除、胆总管探查、空肠造瘘及大网膜切除术，手术中尽可能不干扰胰腺。32例患者全部存活，均未行第2次手术，无假性囊肿形成。

Type I Mirizzi syndrome treated with laparoscopic cholecystectomy and type Ⅱ with choledochotomy and T??tube drainage,suturing fistula and retaining partial gallbladder wall is safe and feasible.

Mirizzi综合征I型行LC、II型行胆总管T管引流+保留部分胆囊壁缝合瘘口的手术安全可行。

In the second operation, the cases receiving choleeystostomy had less peritoneal adhesion, anatomic structure changes, haemorrhage[(30-50) mL vs (100-200) mL] and operation time[(2.5-3.0) h vs (3.5-5.0) h] than those receiving choledochotomy with T-tube drainage ,and did not appear inadequate drainage for cystic duet obstruction.

而Ⅰ期行胆囊造瘘术的患儿，未发现有因胆囊管梗阻而致胆汁引流不畅者，且Ⅱ期手术时胆总管周围结构较清晰，手术操作相对容易、出血少(30~50mL)、耗时短(2.5~3.0h)。

Methods Of 18 chylous fistulas,15 were left-sided and 3 were right-sided.

18例乳糜瘘中左15例，右3例。

Results 83.3％ chylous fistula occured from 1 to 3 postoperative days.

结果 83.3 ％(15/18)的乳糜瘘发生于手术后前3天。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。