胆囊切除术

Methods Clinical data of raining and successfully perform laparoscopic operation included cholecystectomy, appendectomy and ovarian cystectomy was analyzed retrospectively.

回顾分析培训及成功应用腹腔镜进行胆囊、阑尾切除术及卵巢囊肿切除术患者的临床资料。

Ultrasound,ERCP,MRCP,liver enzyme profile and reoperation confirmed the folowing: Extra-hepatic bile duct or the right hepatic duct was ligated in 9 cases,common bile duct residual stone in 6,partial gallbladder or gallbladder duct stone in 4,biliary leak in 4, cholangitic hepatitis in 4,hepatitis B or posthepatitis cirrhosis in 5,icterus after blood transfusion in 2,hemobilia in 2, ligation of right branch of hepatic artery in 2, and icterus of unknown causes in 5 cases.

经B超，ERCP，MRCP和肝酶谱及再手术等证实：肝外胆管或右肝管结扎9例，胆总管遗漏结石6例，残留胆囊或胆囊管结石4例，胆瘘4例，毛细胆管肝炎4例，乙肝或肝炎后肝硬化5例，输血后黄疸2例，胆道出血2例，肝右动脉结扎2例，不明原因黄疸5例。再手术18例，死亡1例。结论：详细的病史资料、充分的术前检查、细致的手术操作是预防胆囊切除术后黄疸的必要前提。

The case number of duodenopancreatectomy,cholecystojejunostomy, cholecystoduodenostomy, gastrojejunostomy, cholecystostomy, choledochoduodenostomy, choledochjejunalostomy, exploration of the common bile duct, and T tube drain were 43, 20, 3, 19, 4, 4, 21, 18, 7 respectively.

行胰十二指肠切除术43例，胆囊空肠吻合术20例，胆囊十二指肠吻合术3例，胃空肠吻合术19例，胆囊造瘘术4例，胆总管十二指肠吻合术4例，胆总管空肠吻合术21例，胆总管探查、T管引流18例，剖腹探查术7例。

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％）。

Objective:To explore the feasibility of nonclosure and suture gallbladder stump after the subtotal laparoscopic cholecystectomy with residual gallbladder ampullae and cystic duct.

目的：探讨残留部分胆囊壶腹或困难胆囊行腹腔镜胆囊大部切除术不闭锁缝合胆囊残端的可行性。

CDRS and damage of biliary tract can be avoided after nonclosure and suture gallbladder stump in the subtotal laparoscopic cholecystectomy reserving gallbladder ampullae and cystic duct.Bile leakage can be cured after shorttime prophylactic drainage.

Calot三角解剖困难时残留部分胆囊壶腹或胆囊管的腹腔镜胆囊大部切除术，术中不闭锁缝合胆囊残端可以避免发生CDRS及误伤肝外胆管等，出现胆漏经过短期持续腹腔引流后可自愈。

Methods 8cases severe adherence acute cholecystitis,10cases repeatedly broken out,the gallbladder recrease fibross,2cases of Mirizzi sydrome the chololith occlude the neck of the cyst,the total chole-cystectomy is difficult,partly retain the gallbladder back wall of cyst,the mucosa is damaged by electrotore,partly anat-omize the cyst duct,close the duct in the proper postion.

目的 总结20例腹腔镜胆囊次全切除术的临床应用经验方法 8例粘连严重处于炎症急性期，10例反复发作胆囊壁纤维增厚，2例Mirizzi综合征结石嵌顿在胆囊颈部，强行完整切除胆囊困难，采取保留部分胆囊后壁，残留黏膜予以破坏，部分游离胆囊管，在适当位置关闭胆囊管。

Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy).

胆囊癌患者1例合并有中肝叶、胃窦、十二指肠、胰头及横结肠的广泛侵犯。经充分的术前准备，我们为其施行了根治性切除术，即胰十二指肠切除术+中肝叶切除术+横结肠切除术。

Results: 3 cases of gall duct injury, 2 cases of remained cystic duct fistulas, 2 cases of convertion into open surgery due to tear of posterior branch of cystic artery Conclusion: Strict preoperative examination and operation protocol can greatly reduce the complications of laparoscopic cholecystectomy.

结果：胆管损伤3例，胆囊管残端瘘2例，胆囊动脉后支撕脱出血中转开腹止血术2例。结论：严格的术前检查和规范的手术程序可大大减少腹腔镜胆囊切除术后的并发症。

Results: 5 protuberances from outside organ (aorta, n=2; spleen, n=1; gallblader, n=1; left hepatic lobe, n=1) and 82 SMTs were detected by mEUS including 45 leiomyomas (esophageal, n=38; gastric. N=7), 17 benign strornal tumours. 6 malignent stromal tumours in stomach. 4 Jipomas (esophageal, n=1; gastric, n=3), 3 varices in gastric fundus. 4 etopic pacreaces in stomach 3 cysts in duodenum. 19 leiomyomas derived from muscularis mucosa, 4 lipomas and 3 cysts derived from suhmucosa were resected by endoscopic snare cauterization. 3 varices in fundus were treated by nylon ligation. 5 malignent stromal tumours were resected surgically. Of which 30 were identified by pathology except 1 malignent stromal tumour was misdiagnosed as leiomyoma by EUS.

结果：mEUS检查的87例患者中，发现消化道壁外压迫5例（其中主动脉弓2例，脾脏1例，胆囊及肝左叶各1例）；粘膜下肿瘤82例，包括平滑肌瘤45例，良性间质瘤17例，恶性间质瘤6例，脂肪瘤4例，静脉瘤3例，异位胰腺4例，囊肿3例。19例起源于粘膜肌层的平滑肌瘤行高频电切除术切除，3例静脉瘤行尼龙圈套结扎，4例脂肪瘤及3例囊肿行高频电切除。5例恶性间质瘤行手术治疗。1例平滑肌瘤，切除后病理诊断为恶性间质瘤，其余的病理诊断与超声诊断相符。

On the other hand, the more important thing is because the urban housing is a kind of heterogeneity products.

另一方面，更重要的是由于城市住房是一种异质性产品。

Climate histogram is the fall that collects place measure calm value, cent serves as cross axle for a few equal interval, the area that the frequency that the value appears according to place is accumulated and becomes will be determined inside each interval, discharge the graph that rise with post, also be called histogram.

气候直方图是将所收集的降水量测定值，分为几个相等的区间作为横轴，并将各区间内所测定值依所出现的次数累积而成的面积，用柱子排起来的图形，也叫做柱状图。