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Objective To investigate the causes,preventive measures and treatment of digestive tract injury during laparoscopic cholecystectomy (LC). Methods From January 2000 to December 2007,totally 21 640 patients underwent LC in our hospital,among them,16 had digestive tract injury including injuries in the stomach and duodenum in 14 patients,in the colon in 1,and in the ileum in 1. Results Among the 16 cases,13 were detected during the operation,and thus laparoscopic repair were performed on 3 of the cases,and conversion to open surgery were carried out for the other 10 for repair of the injured tract (7 cases) or major resection of the stomach and Roux-en-Y anastomosis (3 cases). The other 3 patients were confirmed after LC;they received open surgery for repair of the ileum,colostomy or intra-abdominal cavity drainage. In the 16 cases,one patient died of duodenal leakage complicated with multiple organ dysfunction syndrome in 7 days after the operation;the other 15 patients were cured and discharged from hospital without severe complications. Conclusions Most of the digestive tract injury cases during LC are caused by pericholecystic inflammatory adhesion,which leads to insufficient exposure of the surgical field resulting in the tear or perforation of the digestive tract. Proper treatment in early stage is the key to the prognosis of the patients and prevention of severe complications.
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Objective To focus on the causes and management of complications after laparoscopic cholecystctomy (LC). Methods A retrospective analysis of clinical records of 13 278 patients undergoing LC in this hospital from March 1991 to July 2003 was made. Results Complications occurred in 110 patients (0.83%), involving 19 cases of bile duct injuries (0.14%), 37 cases of bile leakage (0.28%), 31 cases of residual calculi in common bile duct (0.23%), 4 cases of intraabdominal hemorrhage (0.03%), 5 cases of gastrointestinal injury (0.04%), 3 cases of intraabdominal abscess (0.02%), 6 cases of incisional infection or hernia (0.05%) and 5 cases of serious subcutaneous emphysema (0.04%), respectively. Five patients died (0.04%). Conclusions The major complications after LC include bile duct injury, bile leakage and residual calculus. Most of complications are preventable and curable.
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Objective To explore the effect of ulinastatin trypin inhibitor on inhibiting pancreatic secretion and preventing and curing pancreatic fistula in patients underwent pancreatodudenectomy.Methods 45 cases underwent pancreatodudenectomy were not given ulinastatin as control group postoperatively,32 patients underwent pancreatodudenectomy were intravenously driped by ulinastatin 100,000u solution in physiologic saline,every 12 hours (Bid) for 5～8days.Child's pancreatodudenectomy was adopted in all the cases. Results Pancreatic secretion at postoperative 120h in ulinastatin group (138 26?114 74)ml/d were significantly lower than those of control group (248 56?106 75)ml/d (P
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Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.
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Objective To investigate the risk factors leading to complications in patients undergoing laparoscopic cholecystectomy (LC). Methods Clinical data of 11?974 patients undergoing LC from Mar. 1991 to June 2003 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to surgical complications. Data were analyzed by ?2 test and Logistic regression. Results The overall operative complication rate was 1.896%. The procedure was shifted to open surgery in 2.389% of all cases, Logistic regression analysis revealed that Calot triangle adhesion, stage, expertise of the team, gallbladder wall thickness, gallbladder and vicinity adhesion were important risk factors for complications. Conclusion LC complications can be prevented by good training, strictly following protocol, and timely shifting to open surgery.
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Objective To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury.Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively.Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases,acute and subacute cholecystitis in 432 cases,cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases.Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis).The average operation time was 43.5 minutes.Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage,and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage,infection or death.The mean hospitalization time after operation was 5.5 days.Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.
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Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P