ABSTRACT
Objective To study the microinvasive treatment of post-gastrectomy acute cholecystisis. Methods Teweenty-eight cases of post-gastrectomy acute cholecystitis were treated by routine non-operative method first, if cases with no apparent relief after 24h of treatment were further treated with percutanous transhepatic gallbladder puncture and drainage(PTGD) guided by ultrasonography. Results Five cases were treated by non-operative method with complete relief within 24 hours. PTGD was done successfully in all the other 23 cases.In cases with ideal bile drainage at the time of intubation, the patients had immediate marked relief of their symptoms and signs, and they fully recovered within 3~7 days.Conclusions Ultrasound guided PTGD is an effective treatment for post-gastrectomy acute cholecystitis with the advantages of microinvasion and quick patient recovery.
ABSTRACT
Objective To study the diagnosis and treatment of acute gangrenous cholecystitis in senile (patients), so as to decrease complications and lower the mortality rate. Methods The clinical data of 112 senile patients with acute gangrenous cholecystitis were retrospectived analysed.Results 19 cases(17.0%) of the 112 patients had hyperpyrexia, 8(7.1%) had icterus,11(17.0%) had a mass in the right upper abdomen, 26(23.2%) had symptoms of peritonitis; 11(9.8%) were complicated with acute edematous pancreatitis, 5(4.5%) had acute obstructive suppurative cholangitis, 6(5.4%) had septic shock. All of the 112 patients underwent surgery. At operation, 79 of 95 cases of acute calculous cholecystitis had (gangrene) of gallbladder,16(16.8%) had gangrene with perforation; in 17 cases with acute non-calculous cholecystitis had gangrene of gallbladder, 9(52.9%) had gangrene with perforation. Of the 112 patients, 86 underwent cholecystectomy, 18 underwent partial cholecystectomy, 5 underwent cholecystectomy with bile duct exploration and T tube drainage, and 3 underwent cholecystostomy 104 patients(92.9%) were cured, 8 patients(7.1%) died, and 9(8.7%) of the 104 cured patients had postoperative complications. (Conclusions) Acute gangrenous cholecystitis in senile patients should be definitely diagnosed as soon as (possible), co-existent diseases should be correctly treated, emergency operation should be performed with in 24 hours of onset of symptoms(or in the shortest time after admission), and a suitable operation should be (selected).
ABSTRACT
Objective To determine the feasibility and management of the laparoscopic cholecystectomy (LC)for acute cholecystitis. Methods The clinical data of 106 patients with acute cholecystitis underwent LC were reviewed retrospectively. Results Six cases were converted into laparotomy and LC were successfully performed in other 100 cases. No complications occurred in this series. Conclusions LC is feasible for acute cholecystitis;the skill and experience of the operator is the key to the success of the operation.
ABSTRACT
Objective To summarize the clinical experience of laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods Clinical records of 58 cases of acute cholecystitis treated by LC from March 1998 to May 2004 were respectively reviewed.Results Intraoperative cholangiography was conducted in 6 cases,5 of which were found to have common bile duct stones.Of the 5 cases,2 underwent LC combined with choledoscopic choledochotomy, stone removal and T tube drainage; the other 3 cases had ill defined relationship of Calot′s triangle and underwent conversion to open choledochotomy with stone removal and T tube drainage.In 52 cases were diagnosed as simple gallbladder stones, LC was successfully accomplished in 50 cases and conversion to open surgery was required in 2 cases because of serious inflammatory adhesions.In this study 1 case had jaundice after operation and 3 cases had leakage of bile,and all recovered on conservative treatment . Conclusions LC can be performed safely in the majority of cases of acute cholecystitis.