Objective To explore the nursing effect of using Neiguan acupoint massage combined with chewing gum in patients undergoing day-case laparoscopic cholecystectomy. Methods A prospective study was conducted on patients who underwent day-case laparoscopic cholecystectomy in West China Hospital of Sichuan University between March 2023 and March 2024. The patients were randomly divided into the control group and the intervention group according to a random number table. The control group received routine care, while the intervention group received chewing gum and Neiguan acupoint massage intervention at the P6 acupoint in addition to routine care. The incidence of postoperative nausea and vomiting (PONV), pain scores, gastrointestinal function recovery time, medication use, and hospitalization related indicators were compared between the two groups of patients after surgery. Results A total of 298 patients were included. Among them, there were 163 cases in the control group and 135 cases in the intervention group. The incidence of PONV at 0.5 and 2 hours after surgery and the pain scores at 6, 12, and 24 hours after surgery in the intervention group were lower than those in the control group (P<0.05). The first bowel sounds recovery time, anal exhaust time, and eating time in the intervention group were shorter than those in the control group (P<0.05). Twenty-four hours after surgery, the usage rate of analgesic drugs (6.67% vs. 14.11%) and the usage rate of rescue antiemetic drugs (2.96% vs. 8.59%) in the intervention group were lower than those in the control group (P<0.05). There was no statistically significant difference in the delayed discharge rate or total cost between the two groups (P>0.05). The nursing satisfaction of the intervention group was higher than that of the control group (99.26% vs. 93.25%, P<0.05). Conclusions After the combination of Neiguan acupoint massage and chewing gum intervention in patients undergoingin day-case laparoscopic cholecystectomy, the PONV incidence and pain are significantly reduced, gastrointestinal functions recover faster, drug use rate is low, patient nursing satisfaction is high. This method can be promoted and applied.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
ObjectiveTo explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. MethodsThe patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. ResultsA total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). ConclusionAccording to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.
Objective To explore the feasibility and safety of daytime laparoscopic cholecystectomy in high-altitude areas. Methods Clinical data of patients with gallstones undergoing laparoscopic cholecystectomy admitted to Qinghai Red Cross Hospital between January and December 2023 were retrospectively collected. Patients were divided into daytime surgery group and routine surgery group according to their hospitalization method. The gender, age, ethnicity, American Society of Anesthesiologists classification, comorbidities, postoperative pain, postoperative indwelling drainage tube, postoperative nausea and vomiting, overall satisfaction, length of hospital stay, and hospitalization costs of the two groups of patients were compared. Results A total of 95 patients who underwent daytime surgery and 186 patients who underwent routine surgery were included. There was no statistically significant difference in gender, age, comorbidities, or American Society of Anesthesiologists classification between the two groups of patients (P>0.05). The proportion of Han patients in the daytime surgery group was higher than that in the routine surgery group (69.5% vs. 34.4%, P<0.05). All patients successfully completed the surgery without any serious complication. There was no statistically significant difference in postoperative indwelling drainage tube, postoperative nausea and vomiting, postoperative pain, or overall satisfaction between the two groups of patients (P>0.05). The length of hospital stay [(1.03±0.17) vs. (5.30±1.53) d] and hospitalization expenses [(8104.97±660.65) vs. (8947.82±746.19) yuan] in the daytime surgery group were lower than those in the routine surgery group (P<0.05). Conclusion Daytime laparoscopic cholecystectomy is safe and feasible for patients in high-altitude areas without comorbidities or with stable control of comorbidities, and is beneficial for reducing the medical burden on patients.
Objective To explore the feasibility of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis, and to provide evidence based medicine for clinical treatment. Methods A total of 160 cases of acute cholecystitis who received treatment in our hospital from Jan. 2012 to Dec. 2015 were randomly divided into single incision group (n=80, received single incision laparoscopic cholecystectomy) and three incisions group (n=80, received three incisions laparoscopic cholecystectomy). The clinical and laboratory indexes were compared between the 2 groups. Results Compared with the three incisions group, there were statistically significant differences in the operation time, incision pain score, and subjective satisfaction, which were better in single incision group (P<0.05). But there was no significant difference in the blood loss, bed time, anal exhaust time, recovery time of intestinal peristalsis, hospitalization time, incidence of complication (including abdominal infection, bile duct injury, biliary fistula, and incision infection), ratios of T cell subsets (including CD3, CD4, and CD8 T cell), levels of immunoglobulin (including IgA, IgG, and IgM), and level of C reactive protein (P>0.05). Conclusions The effectiveness of single incision laparoscopic cholecystectomy is as good as three incisions laparoscopic cholecystectomy, but this single incision laparoscopic surgery is difficult, and its indications should be cautious. Single incision laparoscopic cholecystectomy is more suitable for patients undergoing elective cholecystectomy.
ObjectiveTo investigate the long-term efficacy of laparoscopic cholecystectomy (LC) for gallbladder cancer.MethodThe clinical data of 52 patients with gallbladder cancer only underwent LC from January 1998 to December 2018 in the Peking Union Medical College Hospital were analyzed retrospectively.ResultsFifty-two patients met the inclusion criteria were included, including 23 males and 29 females. The age was (67±12) years. Fifty-two patients were treated with LC because of gallbladder occupying or gallstone. Twenty-three patients were diagnosed as incidental gallbladder cancer after the surgery, while 29 patients were diagnosed as the gallbladder cancer before or during the operation. Eleven patients with T1a lesions received the close follow-up, the other 41 patients refused the radical operation due to the advanced age, severe underlying diseases or their own preferences. Five cases of postoperative complications were observed. All patients were followed-up for (40.2±33.8) months, 21 patients survived and 31 died. The dead patients had an older age, longer hospital stays, and later T stage (P<0.050) as compared with the living patients. The patients with T1a lesions had significantly longer survival time than those with T1b and above (113.5 months versus 39.6 months, P<0.001).ConclusionsLC is a radical operation in T1a lesions. At the same time, it can meet the requirements of postoperative life quality for some special patients due to its safety and low postoperative complication rate.
Objective To explore the effect of multimodal pain management in the perioperative period of ambulatory laparoscopic cholecystectomy. Methods Non-randomized historical control method was adopted. Patients who underwent laparoscopic cholecystectomy in the Day Surgery Center of West China Hospital, Sichuan University were included. The patients who received single modal pain management between January and May 2020 were taken as the control group, and the patients who received multimodal pain management between January and May 2021 were taken as the trial group. The postoperative pain and pain-related indicators of the two groups were compared. Results A total of 731 patients were included, including 496 in the trial group and 235 in the control group. There was no significant difference in gender, age, body mass index, nationality, education level, diagnosis, marriage and occupation between the two groups (P>0.05). There were 41 patients with moderate or above pain after surgery in the trial group, of which 3 patients were accompanied by severe nausea and vomiting. There were 41 patients with moderate or above pain after surgery in the control group, of which 4 patients were accompanied by severe nausea and vomiting. The incidence of moderate or above postoperative pain (8.3% vs. 17.4%) and post-discharge pain (0.0% vs. 1.3%) in the trial group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of postoperative severe nausea and vomiting and delayed discharge due to postoperative pain between the two groups (P>0.05). There was no statistically significant difference between the two groups patients with moderate or above pain in gender, age, body mass index, education level, diagnosis, time from the onset of pain to the end of surgery, pain location, pain nature, use rate of antiemetic drugs, and score after treatment (P>0.05). The majority of pain sites were surgical incision pain, and the nature of pain was mostly swelling pain. The pain score of patients with moderate or above pain in the trial group was lower than that of the control group (4.4±0.6 vs. 4.9±1.1, P<0.05). Conclusion Multimodal pain management reduces postoperative pain of patients undergoing ambulatory laparoscopic cholecystectomy by means of assessment, medication, procedure improvement, health education, which can provide guarantee for perioperative quality management of ambulatory laparoscopic cholecystectomy.
Objective To investigate the effect of postoperative sleep disturbance by infusion of low dose esketamine during ambulatory laparoscopic cholecystectomy. Methods Patients undergoing ambulatory laparoscopic cholecystectomy under general anesthesia in General Hospital of Northern Theater Command between August and November 2024 were selected. They were randomly divided into esketamine group and control group based on a random number generator. Patients in the esketamine group received a continuous infusion of esketamine [0.3 mg/(kg·h)] during the operation. Patients in the control group received the equivalent volume of saline. The scores of the Athens Insomnia Scale on the first day before surgery, the first day after surgery, and the third day after surgery, the incidence of sleep disturbance and the Hospital Anxiety and Depression Scale score on the first day and the third day after surgery, mean artial pressure and heart rate during surgery, operation time, anesthesia time, recovery time, total dosage of remifetanil and vasoactive drug, postoperative adverse reactions, and the Visual Analogue Scale score on the day of surgery and the first day after surgery were compared between the two groups. Results A total of 105 patients were included, including 52 in the control group and 53 in the esketamine group. The differences were statistically significant in the incidence of sleep disorders on the first day after surgery (22.64% vs. 46.15%; χ2=6.440, P=0.011), the Athens Insomnia Scale score on the first day after surgery [4 (1.5, 5) vs. 5 (4, 7); Z=−2.933, P=0.003] , the cumulative amount of remifentanil used during surgery [884 (600, 1 112) vs. 572 (476, 872) μg; Z=−2.774, P=0.006], and the Visual Analogue Scale score on the day of surgery [2 (2, 3) vs. 3 (2, 3); Z=−2.488, P=0.013] between the esketamine group and the control group. There was no significant difference in mean arterial pressure, heart rate, operation time, anesthesia time, recovery time, vasoactive drug dosage, Hospital Anxiety and Depression Scale score or incidence of postoperative adverse reactions between the two groups (P＞0.05). Conclusion Continuous intraoperative infusion of low dose esketamine can improve postoperative sleep disturbance, without increasing the incidence of postoperative adverse reactions in patients undergoing ambulatory laparoscopic cholecystectomy.
ObjectiveTo investigate the clinical value of laparoscopic cholecystectomy following “A-B-D” approach applied in the operation of acute suppurative or gangrenous cholecystitis.MethodsWe sought out 45 patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the “A-B-D” approach in People’s Hospital of Leshan from Sep. 2019 to Dec. 2020 as the observation group (ABD observation group), and sought out 50 patients with the same diseases but treated by conventional laparoscopic cholecystectomy from Jun. 2018 to Aug. 2019 as the matched group (conventional matched group). We analyzed and compared the parameters related to safety and efficacy of the two groups retrospectively.ResultsA total of 95 patients were included, including 45 patients in the ABD observation group (26 cases of acute suppurative cholecystitis, 19 cases of acute gangrenous cholecystitis) and 50 patients in the conventional matched group (24 cases of acute suppurative cholecystitis, 26 cases of acute gangrenous cholecystitis). There were no significant differences in age, gender, body mass index, disease composition, gallbladder condition, and preoperative complications between the two groups (P>0.05). There was no bile duct injury case in the ABD observation group (0), while there were 4 cases (8.0%) in the conventional matched group, but the statistical results showed no statistical significance between the two groups (P=0.054). One case (2.2%) in the ABD observation group converted to laparotomy, which was significantly lower than the 10 cases (20.0%) in the conventional matched group, and the difference was statistically significant (P=0.017). In addition, there were no significant differences for other parameters including operative time, postoperative hospital stay, incidences of intraoperative bleeding and postoperative bleeding between the two groups (P>0.05).ConclusionsThe laparoscopic cholecystectomy following the “A-B-D” approach can help distinguish the anatomical structure of cystic duct and extrahepatic bile duct clearly, and it can help prevent biliary tract injury effectively and reduce the probability of conversion to laparotomy. It is worthy of clinical application and promotion, especially in the majority of county hospitals.