胆总管石切除术

Methods HALS was used in 202 cases including 94 cases of hepatectomy, 29 cases of splenectomy, 28 cases of modified Sugiura procedure, 4 cases of combined hepatectomyand splenectomy, 41 cases of combined hepatectomy and choledocholithotomy, one case of combinedhepatectomy and total hysterectomy and 5 cases of combined splenectomy with choledocholithotomy.

对202例肝或脾外科疾病进行手助腹腔镜手术，包括肝切除94例，脾切除29例，改良Sugiura术28例，肝脾联合切除4例，肝子宫联合切除1例，肝切除加胆总管取石术41例，脾切除加胆总管取石术5例。

Methods 30 cases of hepatolithiasis patients were divided randomly into following two groups: 15 did lobectomy of liver, 15 did choledocholithotomy.

30例肝内胆管结石的病人随机分成两组， 15例行肝叶切除术，另 15例行胆总管切开取石、 T管引流术。

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。

All of those who did choledocholithotomy had remaining calculi, and with the help of endoscope, 4 cases still had remaining calculi, only 33.3％ cases had excellent results.

行胆总管切开术的，术后残石 15例(100％)，经术后胆道镜，仍有 4例未取净。随访结果表明：肝叶切除术优良率为 80％，胆总管切开术的优良率为 33.3％。

The indications for the initial CT were the staging of small-bowel tumor and colon cancer, nonspecific abdominal discomfort, lier abscess, confirmation of the residual stone after open cholecystectomy and choledocholithotomy, and common bile duct stone and lier abscess.

所有病人均发现胰腺有异常，初始CT检查有小肠肿瘤和结肠癌、非特异性腹部不适、肝脓肿、胆囊切除术和胆总管石切除术后的残余结石、总胆管结石伴肝脓肿。

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 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。