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find Keyword "一期缝合" 14 results
  • Feasibility Through Confluence of Common Bile Duct and Cystic Duct Approach with Mini-Incision in LaparoscopicCommon Bile Duct Exploration

    Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct (CBD) and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct, and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy, the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation, intraoperativecholangiography, removal of stones with help of choledochoscope, and removal drainage tube after operation was from 90 to 200 min with an average of 100min, 3 to 10min with an average of 6min, 5 to 15 min with an average of 8 min,and 3-5d with an average of 3.5d , respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage, abdominal pain, and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection, T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.

    Release date:2016-09-08 10:23 Export PDF Favorites Scan
  • 腹腔镜胆总管探查术后胆总管一期缝合与T管引流的疗效观察

    目的比较腹腔镜胆总管探查术后胆总管一期缝合与T管引流对临床治疗胆总管结石患者的影响 方法将2012年4月至2015年12月期间笔者所在医院收治的胆总管结石拟行腹腔镜胆总管切开取石术的90例患者作为研究对象,按随机数字表法分为观察组和对照组,数字为偶数者为观察组,奇数者为对照组,每组45例。观察组进行胆总管一期缝合,对照组行T管引流,记录并比较2组患者的手术情况及术后恢复情况,并对2组术后并发症的发生情况进行比较。 结果观察组手术时间明显短于对照组,差异有统计学意义(P<0.05),2组术中出血量比较差异无统计学意义(P>0.05);观察组患者术后肛门排气时间、下床活动时间、住院时间及恢复工作时间均明显短于对照组,差异有统计学意义(P<0.05);此外观察组住院费用亦明显少于对照组,差异有统计学意义(P<0.05);观察组患者术后并发症的发生率明显低于对照组,差异有统计学意义(P<0.05)。 结论在严格掌握相关适应证的前提下,采用腹腔镜胆总管切开取石一期缝合临床效果显著,具有手术时间短、术后恢复快、安全性高的优势,值得在临床推广使用。

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  • Clinical observation of primary suture following laparoscopic common bile duct exploration in patients aged over 70 years old with common bile duct stones

    Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.

    Release date:2018-10-11 02:52 Export PDF Favorites Scan
  • Study on Indications and Clinical Experience of Primary Suture after Common Bile Duct Exploration

    ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.

    Release date:2016-09-08 04:25 Export PDF Favorites Scan
  • Primary closureversus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis

    Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.

    Release date:2017-04-18 03:08 Export PDF Favorites Scan
  • Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases)

    Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.

    Release date:2016-09-08 11:05 Export PDF Favorites Scan
  • Clinical Experience of Laparoscopic Choledocholithotomy and Primary Suture: a Report of 58 Cases

    ObjectiveTo explore the clinical efficacy and surgical techniques of laparoscopic choledocholithotomy and primary suture. MethodsWe retrospectively analyzed the clinical data of 58 patients who underwent laparoscopic choledocholithotomy and primary suture between January 2009 and December 2014. ResultsAll the 58 patients underwent the surgery successfully. Operation time was 45-125 minutes, averaging 75 minutes. Intraoperative blood loss was between 10 and 50 mL with an average of 20 mL. Postoperative hospital stay was 5-14 days with an average of 7 days. Four cases of biliary leakage were cured by conservative treatment. ConclusionWith operation indications strictly grasped and skillful operation techniques, laparoscopic choledocholithotomy and primary suture are safe and reliable with a good curative effect.

    Release date:2016-10-02 04:54 Export PDF Favorites Scan
  • Primary Suture versus T-tube Drainage after Laparoscopic Common Bile Duct Stone Exploration: A Systematic Review

    Objective To assess the benefits and harms of routine primary suture (LBEPS) versus T-tube drainage (LCHTD) following laparoscopic common bile duct stone exploration. Methods The randomized controlled trials (RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2010), PubMed (1978 to 2010), EMbase (1966 to 2010), CBMdisc (1978 to 2010), and CNKI (1979 to 2010); and the relevant published and unpublished data and their references were also searched by hand. The data were extracted and the quality was evaluated by two reviewers independently, and the RevMan 5.0 software was used for data analysis. Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included. The meta-analysis showed that compared with LCHTD, LBEPS was better in shortening operation time (WMD= –17.11, 95%CI –25.86 to –8.36), abdominal drainage time (WMD= –0.74, 95%CI –1.39 to –0.10) and post-operative hospitalization time (WMD= –3.30, 95%CI –3.67 to –2.92), in lowering hospital expenses (WMD= –2 998.75, 95%CI –4 396.24 to –1 601.26) and in reducing the complications due to T-tube such as tube detaching, bile leakage after tube drawing, and choleperitonitis (RR=0.56, 95%CI 0.29 to 1.09). Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication. Due to the low quality of the included studies which decreases the reliability of this conclusion, more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.

    Release date:2016-09-07 11:01 Export PDF Favorites Scan
  • 单J管内引流在胆总管一期缝合术中的应用

    目的探讨单J管内引流在胆总管探查术后一期缝合中的作用。 方法回顾性分析2008年-2013年34例因胆管结石或胆总管增粗行胆总管探查后放置单J管内引流并一期缝合的患者的临床资料。 结果患者均顺利完成手术,术后7~10 d出院,平均8.7 d;随访1~4年,平均2.9年。单J管均于术后10~25 d(平均20.2 d)随粪便排出;仅1例患者于术后1年出现胆管炎,余无并发症发生。 结论胆总管探查术后放置单J管内引流可有效防止术后因胆总管末端水肿所致的胆漏等并发症,术式简单安全,值得推广。

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  • Analysis of Effect and Quality of Laparoscopic Cholecystectomy with Common Bile Duct Exploration,Built-in-Tube Drainage, and Primary Suture

    ObjectiveTo compare and evaluate the effect and quality of T-tube drainage and bulit-in-tube drainage plus primary suture after laparoscopic cholecystectomy (LC). MethodsA clinical trial was taken in 79 cases with T-tube drainage (control group) and 62 cases with built-in-tube drainage (observation group). The treatment success rate, incidence of complications, bilirubin recovered time, length of stay, recuperation time, and treatment cost were measured and compared between the two groups. ResultsThere were no statistically significant differences between the two groups in treatment success rate, incidences of complications, and bilirubin recovered time of patients (Pgt;0.05), while length of stay, recuperation time, and treatment cost of patients in observation group were significantly less than those in control group (Plt;0.05). ConclusionsBuilt-in-tube drainage plus primary suture after LC and common bile duct exploration could achieve the same therapeutic effect as the traditional T-tube drainage with less length of stay, recuperation time, and treatment cost.

    Release date:2016-09-08 10:41 Export PDF Favorites Scan
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