腹腔镜胆囊切除术对机体代谢炎症反应的影响
|
摘要
目的:探讨微创技术与传统外科手术对患者的代谢影响。微创理念是现代外科最为重要的内容之一,外科界关于其内涵和外延一直存在着不同的观点。随着时代的前进,正是争议和讨论才使得微创理念不断丰富,微创技术得以进步。微创是现代外科的必然走向。腹腔镜在普外领域是最具代表性的微创技术,以此为例探讨微创技术与传统外科的关系更具典型意义,探讨两种术式对患者的代谢影响更显必要。方法:选择不同的胆囊切除术术式患者42例,22例为试验组,传统开腹胆囊切除手术为对照组,手术前后分别监测血常规、肝、肾功能、血糖变化情况。结果:不同术式,即传统手术与微创手术,在切口的大小、损伤的大小、外观是否美观,患者的耐受性上,心理感受传统手术可能处于劣势,但就本研究的结果而言,两者对代谢的影响基本一致,本人以为腔镜外科应是传统外科的发展、延伸,两者相辅相成,手术创伤不仅指入路损伤,更包括手术并发症和远期效果等等,两者对代谢影响无明显差别。结论:从选择的六项指标看,不论是微创技术还是传统手术,都是创伤对机体产生的影响,两者没有明显的差别。
Objective: to compare the metabolism chang after conventional open cholecystectomy, and laparoscopic cholecystectomy. The principle of Microport is one of the most important contentses in modern surgery, There are different standpoint outside in the surgery field concerning its content and postpone. Along with the headway of the ages, there are exactly the controversy and discussion to just make the principle of microport continuously abundant, the technique of microport can progress. Microport is the inevitable alignment of the modern surgery. The celioscope is the most representative microport technique in general surgery field, take it as an example inquiry into microport technique and the tradition surgery of the relation has the typical model meaning more, the metabolism influence that inquiries into two kinds of surgery types to the sufferer shows more necessity. Method: the clinical materials of 22 cases underwent total laparoscopic cholecystectomy group and 20 cases open cholecystectomy group between may 2005 and December 2006 were compared the operativ time .intraoperative blood loss. Mean time of stay in hospital result; alloperations in LC group were successfully performed with laparoscopic technique, and the mean operation time was 47 min ,mean introperative blood loss 25ml, and hospital stay was 7 days. No serious complications occurred in this group. In OC group, the mean operative time was 118 min .mean introperative blood loss was 108ml ,and mean hospital stay was 12 days. No-serious complications occur, too. There was significant difference in operation blood loss and hospita stay between the group ,(p<0.05) Result: the mental suffering, incision size and wound severity, external appearance in group A were significantly better than group B (p>0.05),.but The blood routine analysis, liver funcion, kidney function, blood glucose level changing before and after the operation in both group have no significant statistic difference.(p>0.05). Conclusion: laparoscopic cholecystectomy is a safe and feasible minimally-invasive surgery, it brings less bleeding, shorter hospital stay . But there was insignificant in metabolism chang.
Objective: to compare the metabolism chang after conventional open cholecystectomy, and laparoscopic cholecystectomy. The principle of Microport is one of the most important contentses in modern surgery, There are different standpoint outside in the surgery field concerning its content and postpone. Along with the headway of the ages, there are exactly the controversy and discussion to just make the principle of microport continuously abundant, the technique of microport can progress. Microport is the inevitable alignment of the modern surgery. The celioscope is the most representative microport technique in general surgery field, take it as an example inquiry into microport technique and the tradition surgery of the relation has the typical model meaning more, the metabolism influence that inquiries into two kinds of surgery types to the sufferer shows more necessity. Method: the clinical materials of 22 cases underwent total laparoscopic cholecystectomy group and 20 cases open cholecystectomy group between may 2005 and December 2006 were compared the operativ time .intraoperative blood loss. Mean time of stay in hospital result; alloperations in LC group were successfully performed with laparoscopic technique, and the mean operation time was 47 min ,mean introperative blood loss 25ml, and hospital stay was 7 days. No serious complications occurred in this group. In OC group, the mean operative time was 118 min .mean introperative blood loss was 108ml ,and mean hospital stay was 12 days. No-serious complications occur, too. There was significant difference in operation blood loss and hospita stay between the group ,(p<0.05) Result: the mental suffering, incision size and wound severity, external appearance in group A were significantly better than group B (p>0.05),.but The blood routine analysis, liver funcion, kidney function, blood glucose level changing before and after the operation in both group have no significant statistic difference.(p>0.05). Conclusion: laparoscopic cholecystectomy is a safe and feasible minimally-invasive surgery, it brings less bleeding, shorter hospital stay . But there was insignificant in metabolism chang.
引文
[1]王存川.《实用腹腔镜外科手术学》
[2]黄志强,外科微创化[J].21世纪外科的趋势—解放军医学杂志;2002;27;95-97
[3]曾毅克,王存川.腔镜乳腺手术的现状和进展[J].中华外科杂志;2004;42;20:1262-1263
[4]毛一雷,BistrianBR.当前外科患者营养支持的几个观点[J].中国实用外科杂志,2000;20:250-252
[5]毛一雷,卢欣.外科术后患者允许性摄入不足的前瞻、随机、对照临床研究[J].中华普通外科杂志,2005,20(17):612-615
[6]Maurice E,Arregui.principles of Laparoscopic Surgery.J Springer-Verlag New York Inc,1995;3-21
[7]陈训如,peter Mack.腹腔镜外科理论与实践.云南科技出版社.1995;1-6
[8]王存川.腹腔镜外科的现状与思考[J].岭南现代外科杂志.2001;1(2):67
[9]Alfred cuschieri,Groge Breci.Laparoscopic Biliadry Surgery.J Oxford:Blackwell Scientific Publications.1991
[10]hugh TB et al.Laparoscopic anatomy of custic artery.Am J Surg.1992;8:320
[11]Fahy BG,Barnas GM.Flowers JL et al.The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery.J Anesth Analg.1995;81:744
[12]Grissom TE.Gootos PJ.Brown R.Pulmonary compliance is not affected by changes in position during laparoscopic surgery.J Anesthesiology.1993;79(suppl 3A):A491
[13]Joris J.honore P.Lamy M.Changes in oxygen transport and ventilation during Laparoscopic cholecystectomy[J].Anesthesiology,1992;77(suppl 3A):A149
[14]Baraka A.Jabbour S.Hammoud R et al.End-tidal carbon dioxide tension during laparoscopic cholecystectomy[J].Anaesthesia.1994;49:304
[15]Gannedahl P,Odeberg S,Brodin LA et al.Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling[J].Acta anaesthesoil Scand,1996;40:160
[16]Porsay DA,greene FL,baysinger CL.Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography[J].Surge Endosc,1995;9:128
[17]Smith I,Benzie RJ,Gordon NL,et al.Cardiovascular effects of peritoneal insuffation of carbon dioxide for laparoscopy.J Br Med J,1971;3:410
[18]Kitano S,Tomikawa M,Iso Y,et al.A safe and simple nethod to maintain a clear field of vision during laparoscopic cholecystectomy[J].Surg Endosc,1992;6:197
[19]Banting S,Shimi S,Vander Velpen G,et al.Abdominal wall lift[J].Surg Endosc,1993;7:57
[20]陈训如,Peter Mack主编.腹腔镜外科理论与实践.昆明,云南科技出版社,1995;123-140
[21]朱江帆主编.普通外科内镜手术学[M].山东科技出版社,2001;85-118
[22]Boike GM,et al.Incisional bowel herniations after operative laparosocopy;a series of nineteen cases and review of the literature.Am J Obster Cynecot,1994;84:765
[23]Cirocco WC,et al.Abdominal wall recurrenue after Laparosupic colectomy for colon cancer[J].Surgery,1994;116:842
[24]Jalkson SA,et al.Does post—laparoscopy pain relate to residueal carbon dixoxide.J Anaeshesia,1996;51:485
[25]Sharp EJ,Spriongall RG,Theodorou NA.Delayed diagnosis of malignant tumors missed at laparoscopic cholecystectomy.J Br J Surg,1994;81:1649
[26]Karem S,Denis P,Elizabeth C,et al.Malignant tumors at laparoscopic chlecyctectomy.J Am J Surg,1996;171:364
[27]Bemelman WA,Wit LT,Delden OM,et al.Diagnostic Laparoscopy combined with laparoscopic ultrasongraphy in staging of cancer of the pancreatic head region.J Br J Surg,1995;82(6):820
[28]John TG.Carcinoma of the pancreatic head and periampullary region,Tumor staging with laparoscopy and laparoscopic ultrasonography.J Annals of Surg,1995;22(2):155
[29]陈训如主编.微创胆道外科手术学[M],第一版.云南科技出版社.2000;123-230
[30]陈训如主编.腹腔镜手术的并发症与对策[M].第一版.云南科技出版社.1997;109-155
[31]王存川,徐以浩,宋逢春.腹腔镜手术中恶性肿瘤的遗漏与发现[J].中华普通外科学杂志,1997;(12)4:245
[32]Payne SR,Ford TF,Wickham JE,Endoscopic management of upper urinary tract stones.J Br J Surg,1985,72:822-824
[33]姜洪池,代文杰.微创观念和微创外科
[34]姜洪池,微创化—外科学发展的不懈追求[J].中国实用外科杂志,2004,24:472-474
[35]王明亮,蒋渝,郑民华等.腹腔镜胆囊切除术对机体代谢炎症反应的影响[J].中国实用外科学杂志,1999;19:54-55
[36]Jakeways MSR,Mitchll V,Hashim IA,et al.Metabolic and inflammatory response after opern or laparoscopic cholecystectomy.J Br J Surg,1994;81:127
[37]McMahon AJ,O'Dwyer PJ,Cruikshank AM,et al.Comparison of metabolic responses to laparoscopic and minlaparotomy cholecystectomy.J Br J Surg,1993;80:1255
[38]Fritz MD,Herfarth MD,General stress response to conventional and laparoscopic cholecystectomy.J Ann Surg,1995;221(4):372
[39]黎鳌生编.现代创伤学.北京:人民出版社,1996:79
[40]Mansor MA.Neuroendocrine stress response after minimally invasive surgery in pigs.J Surg Endosc,1992;6(6):294
[1]王存州 主编 M.《实用腹腔镜外科手术学》
[2]腹腔镜手术治疗结直肠癌安全性临床研究[J].外科理论与实践,2003,8:361-364
[3]冯波,郑等,Co2对质结肠癌细胞表面黏附分子mRNA表面的影响[J].中华普通外科杂志,2001,20,11:710-712
[4]Fusco MA,Paluzzi MW,abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarinoma of the colon.Report of a case.Dis colon Rectum,1993.36:858-861
[5]黄志强,外科微创化:21世纪外科的趋向[J].解放军医学杂志,2002,27:95-97
[6]王悦华,刘荣,周宁新等,完全腹腔镜规则肝切除的解剖基础与技术问题[J].中华普 通外科杂志,2003,18:403-405
[7]蔡秀军,陈健达等,腹腔镜胆未切除术胆管损伤的危险因素分析[J].中华普通外科杂志,2005,20,6:347-349
[8]曾毅克,王存川,腔镜乳腺癌手术的现状和进展[J].中华外科杂志,2004,42,20:1262-1263
[9]张逊,韩兴鹏,徐医军,腹腔镜在停产外科中的应用[J].中华外科杂志,2005,43,6:400-402
[10]季晓昕,骆成玉,腔镜技术在乳腺疾病中的应用[J].中国普外基础与临床杂志,2004,11:213-215
[11]杨甲梅.原发性肝细胞癌[M].实用肝脾外科学.第1版.科学研究出版社,2003.232-285
[12]Shimada M,Hashizume M,Maechara S,et al.Laparoscopic hepatectomy for hepatocellular carcinoma.Surg Endosc,2001,15:541-544
[13]Biertho L,Waage A,Gagner M.Laparoscopic hepatectomies.J Ann Chir,2002,127:164-170
[14]Antonetti MC,Killelea B,Orlando ⅢR.Hand-assisted laparoscopic liver surgery.Arch Surg,2002,137:407-412
[15]Fong YM,Jarnagin W,Conlon KC,et al.Hand-assisted laparoscopic liver resection,Arch Surg,2000,135:854-859
[16]牟一平,朱一平,徐晓武,等.腹腔镜胰腺囊肿切除术2例[J].中国实用外科学杂志,2002,22:634
[17]Park A,Schwartz R,Tandan V,et al.Laparoscopic pancreatic surgery.Am J Surg,1999,177:158-163
[18]Cuschieri A,Frank TG,Brown S,et al.A new multitool for hand-assisted advanced laparoscopic surgery(HALS).M Surg Endosc,2003,17:1368-1371
[19]Targarona EM,Gracia E,Rodriguez M,et al.Hand-assisted laparoscopic surgery.Arch Surg,2003,138:133-141
[20]Gigot JF,Glineur D,Santiago Azagra J,et al.Laparoscopic liver resection for malignant liver tumors:preliminary results of a multicenter European study.Ann Surg,2002,236:90-97
[21]Ker CG,Chen HY,Juan CC,et al.Laparoscpic subsegmentectomy for hepatocellular carcinoma with cirrhosis.Hepatogastroenterology,2000,47:1260-1263
[22]王锐华,刘荣,周宁新,等.腹腔镜肝切除16例临床分析[J].中国微创外科杂志,2003,3:473-475
[23]Keulemans YC,Bergman JJ,de-Wit LT,et al.Improvement in the management of bile duct injuries[J].Am Coll Surg,1998;187(3):246
[24]Ihasz M,Hung CM,Regoly MJ,et al.Complications of laparoscopic cholecystectomy in hungary:a multicentre study of 13833 patients.Eur J Surg,1997;163(4):267
[25]Najnigier B,Zieniewicz K,Nyckowski P,et al.Complication of laparoscopic cholecystectomy.Wiad Lek,1997;50(1):218
[26]Boutelier P.Complications of laparoscopiccholecystectomy:evaluation study.Bull Acad Natl Med,1998;182(3):617
[27]Torkington T,Pereira J,Chalmers RT,et al.Laparoscopic cholecystectomy,bile duct injury and the British and Irish surgeon.Ann R Coll Surg Engl,1998;80(2):119
[28]Merrie AE,Booth MW,Shah A,et al.Bile duct imaging and injury:a regional audit of laparoscopic cholecystectomy,Aust N Z J Surg,1997;67(10):706
[29]Adamsen S,Hansen DH,Funch JP,et al.Bile duct injury laparoscopic cholecystectomy:a prospective nationwide series.J Am Coll surg,1997;184(6):571
[30]Macfadyen BV,Vecchio R,Ricardo AE,et al.Bile duct injury after laparoscopic cholecystectomy:the united states experience.Surg Endosc,1998;12(4):315
[31]黄志强著.黄志强肝胆外科手术学[M].北京:人民军医出版社,1997:233
[32]陈训如主编.腹腔镜手术的并发症与对策[M].昆明.云南科技出版社,1997:128
[33]黄志强主编.当代胆道外科学[M].上海:上海科学技术文献出版社,1998:648
[34]钱光相,吴孟超,张永杰,等.腹腔镜胆囊切除术胆道损伤的类型及原因分析[J].中华外科学杂志,1995;33(11):647
[35]沈立荣,何志军.高位胆管狭窄处理原则及炎性胆管狭窄整形修复[J].实用外科学杂志,1993;13(1):9
[36]王跃文,李立波,黄金文,等.腹腔镜脾切除术[J].中国内镜杂志,1997;3(6):5
[37]Decker Mlllat B,Guillon F,et al.Laparoscopic splenectomy for benign and malignant hematologic diseases:35 consecutive cases.World J Surg,1998;22(1):62
[38]Schlinkert R,Teotia SS.Laparoscopic splecectomy.Arch surg,1999;134(1):99
[39]Rege RV,Merrian LT,Joehl RJ.Laparoscopic splenectomy.Surg Clin North Am,1996;76(3):459
[40]Tanoue K,Hashizume M,Morita M,et al.Results of laparoscopic splenectomy for immune thrombocytopenic purpura.Am J Surg,1999;177(3):222
[41]Okamoto M,Okamoto HK,Tahara F,et al.Ultrasonographic evidence of association of polyps and atones with gallbladder cancer.Am J Gastroenterol,1999,94(2):446
[42]Collett JA,Allan RB,Chisholm RJ,et al.Gallbladder polyps:pro-spective,study. J Ultrasound Med,1998,17(4):207
[43]Chen CY,Lu CL,chang FY,et al.Risk factors for gallbladder polypsin Chinese population.Am J Gastmenterol,1997,92(11):2066
[44]Chen CY,LU C1,Lee PC,et al.The risk factors for gallstone disease among senior citizens:an oriental study.Hepatogastroentemlogy,1999,46(2):1607
[45]Shinchi K,Kono S,Honjo S,et al.Epidemiology of gallbladder pol-yps:an ultrasonographic study of male self-defense officials in Ja-pan.Scand J Gastroenterol,1994,29(1):7 Segawa K,Arisawa T,Niwa Y,et al.Prevalence of gallbladder polyps among apparently health Japanese:ultrasonographic study.Am J Gastroenterol,1992,87(5):630
[46]Csendes A,Burgos AM,Csendes P,et al.Late follow-up of polypoid lesions of the gallbladder smaller than 10mm.Ann Surg,2001,234(5);657
[47]Kubota K,Bandai Y,Noie T,et al.How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystecto-my? Surgery,1995,117(5):481
[48]杨汉良.胆囊息肉样病变的诊断与手术指征,中国实用外科杂志,1995,15(1):18
[49]Shinkai H;Kimura W,Mato T.Surgical indication for small polypoiesions of the gallbladder.Am J Surg,1998,175(2):114
[50]田伏洲,王孝华,张鸣山,等.胆囊胆固醇沉着病的临床治疗.中国实用外科杂志,1995,15(1):21
[51]Edelman DS.Carcinoma of a gallbladder polyps:treated by laparo-acopic laser cholecystectomy.Surg Iapamsc Endosc,1993,3(2):142
[52]Liu ZH,Zhang XH.40例胆囊息肉样病变的形态学分析及其临床意义.中华病理学杂志,1991,20(4):274
[53]Koga A,Watanabe K,Fukuyama.,et al.Diagnosis and operative indi-cation of polypoid lesions of the gallbladder.Arch Surg,1998,123(1);26,
[54]Smok G,Bantjerodi R,Csendes A.Benign polypoid lesions of the gallbladder:their relation to gallbladder adenocarcinoma.Rev MedChil,1992,120(1):31
[55]Sugiyama M,Atomi Y,Yamato T.Endoscopic ultrasonography for differential diagnosis of polypoid gallbladder lesions:analysis in sur-gical and follow up series.Gut,2000,46(2):250
[56]Gouma DJ.When are gallbladder polyps malignant? HPB Surg,2000,11(6);428
[57]王秋生,黄筵庭.胆囊息肉样病变的特点与手术时机.中国实用外科杂志1995,15(1):9
[58]王秋生,黄筵庭.胆囊息肉样病变的特点与手术时机.中国外科专家经验文集.沈阳:沈阳出版社,2000.926
[59]Terzi C,Sokmen S,Secdin S,et al.Polypoid lesions of the gallblad-der:report of 100cases with special reference to operative indica-tions.Surgery,2000,127(6);622
[60]Yeh CN,Jan YY,Chao TC,et al.Laparoscopic cholecystectomy for polypoid lesions of the gallbladder:a clinicopathologic study.Surg Laparosc Endsc Percutan Tech,2001,11(3):176
[61]邓绍庆,周孝思,张武,等.胆囊息肉样病变中肿瘤和癌前病变的识别.中国外科专家经验文集决沈阳:沈阳出版社,2000.922
[62]吴金生,何显力,高德明,等.胆囊息肉样病变109例分析,中国实用外科杂志;2000,20(2):104
[2]黄志强,外科微创化[J].21世纪外科的趋势—解放军医学杂志;2002;27;95-97
[3]曾毅克,王存川.腔镜乳腺手术的现状和进展[J].中华外科杂志;2004;42;20:1262-1263
[4]毛一雷,BistrianBR.当前外科患者营养支持的几个观点[J].中国实用外科杂志,2000;20:250-252
[5]毛一雷,卢欣.外科术后患者允许性摄入不足的前瞻、随机、对照临床研究[J].中华普通外科杂志,2005,20(17):612-615
[6]Maurice E,Arregui.principles of Laparoscopic Surgery.J Springer-Verlag New York Inc,1995;3-21
[7]陈训如,peter Mack.腹腔镜外科理论与实践.云南科技出版社.1995;1-6
[8]王存川.腹腔镜外科的现状与思考[J].岭南现代外科杂志.2001;1(2):67
[9]Alfred cuschieri,Groge Breci.Laparoscopic Biliadry Surgery.J Oxford:Blackwell Scientific Publications.1991
[10]hugh TB et al.Laparoscopic anatomy of custic artery.Am J Surg.1992;8:320
[11]Fahy BG,Barnas GM.Flowers JL et al.The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery.J Anesth Analg.1995;81:744
[12]Grissom TE.Gootos PJ.Brown R.Pulmonary compliance is not affected by changes in position during laparoscopic surgery.J Anesthesiology.1993;79(suppl 3A):A491
[13]Joris J.honore P.Lamy M.Changes in oxygen transport and ventilation during Laparoscopic cholecystectomy[J].Anesthesiology,1992;77(suppl 3A):A149
[14]Baraka A.Jabbour S.Hammoud R et al.End-tidal carbon dioxide tension during laparoscopic cholecystectomy[J].Anaesthesia.1994;49:304
[15]Gannedahl P,Odeberg S,Brodin LA et al.Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling[J].Acta anaesthesoil Scand,1996;40:160
[16]Porsay DA,greene FL,baysinger CL.Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography[J].Surge Endosc,1995;9:128
[17]Smith I,Benzie RJ,Gordon NL,et al.Cardiovascular effects of peritoneal insuffation of carbon dioxide for laparoscopy.J Br Med J,1971;3:410
[18]Kitano S,Tomikawa M,Iso Y,et al.A safe and simple nethod to maintain a clear field of vision during laparoscopic cholecystectomy[J].Surg Endosc,1992;6:197
[19]Banting S,Shimi S,Vander Velpen G,et al.Abdominal wall lift[J].Surg Endosc,1993;7:57
[20]陈训如,Peter Mack主编.腹腔镜外科理论与实践.昆明,云南科技出版社,1995;123-140
[21]朱江帆主编.普通外科内镜手术学[M].山东科技出版社,2001;85-118
[22]Boike GM,et al.Incisional bowel herniations after operative laparosocopy;a series of nineteen cases and review of the literature.Am J Obster Cynecot,1994;84:765
[23]Cirocco WC,et al.Abdominal wall recurrenue after Laparosupic colectomy for colon cancer[J].Surgery,1994;116:842
[24]Jalkson SA,et al.Does post—laparoscopy pain relate to residueal carbon dixoxide.J Anaeshesia,1996;51:485
[25]Sharp EJ,Spriongall RG,Theodorou NA.Delayed diagnosis of malignant tumors missed at laparoscopic cholecystectomy.J Br J Surg,1994;81:1649
[26]Karem S,Denis P,Elizabeth C,et al.Malignant tumors at laparoscopic chlecyctectomy.J Am J Surg,1996;171:364
[27]Bemelman WA,Wit LT,Delden OM,et al.Diagnostic Laparoscopy combined with laparoscopic ultrasongraphy in staging of cancer of the pancreatic head region.J Br J Surg,1995;82(6):820
[28]John TG.Carcinoma of the pancreatic head and periampullary region,Tumor staging with laparoscopy and laparoscopic ultrasonography.J Annals of Surg,1995;22(2):155
[29]陈训如主编.微创胆道外科手术学[M],第一版.云南科技出版社.2000;123-230
[30]陈训如主编.腹腔镜手术的并发症与对策[M].第一版.云南科技出版社.1997;109-155
[31]王存川,徐以浩,宋逢春.腹腔镜手术中恶性肿瘤的遗漏与发现[J].中华普通外科学杂志,1997;(12)4:245
[32]Payne SR,Ford TF,Wickham JE,Endoscopic management of upper urinary tract stones.J Br J Surg,1985,72:822-824
[33]姜洪池,代文杰.微创观念和微创外科
[34]姜洪池,微创化—外科学发展的不懈追求[J].中国实用外科杂志,2004,24:472-474
[35]王明亮,蒋渝,郑民华等.腹腔镜胆囊切除术对机体代谢炎症反应的影响[J].中国实用外科学杂志,1999;19:54-55
[36]Jakeways MSR,Mitchll V,Hashim IA,et al.Metabolic and inflammatory response after opern or laparoscopic cholecystectomy.J Br J Surg,1994;81:127
[37]McMahon AJ,O'Dwyer PJ,Cruikshank AM,et al.Comparison of metabolic responses to laparoscopic and minlaparotomy cholecystectomy.J Br J Surg,1993;80:1255
[38]Fritz MD,Herfarth MD,General stress response to conventional and laparoscopic cholecystectomy.J Ann Surg,1995;221(4):372
[39]黎鳌生编.现代创伤学.北京:人民出版社,1996:79
[40]Mansor MA.Neuroendocrine stress response after minimally invasive surgery in pigs.J Surg Endosc,1992;6(6):294
[1]王存州 主编 M.《实用腹腔镜外科手术学》
[2]腹腔镜手术治疗结直肠癌安全性临床研究[J].外科理论与实践,2003,8:361-364
[3]冯波,郑等,Co2对质结肠癌细胞表面黏附分子mRNA表面的影响[J].中华普通外科杂志,2001,20,11:710-712
[4]Fusco MA,Paluzzi MW,abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarinoma of the colon.Report of a case.Dis colon Rectum,1993.36:858-861
[5]黄志强,外科微创化:21世纪外科的趋向[J].解放军医学杂志,2002,27:95-97
[6]王悦华,刘荣,周宁新等,完全腹腔镜规则肝切除的解剖基础与技术问题[J].中华普 通外科杂志,2003,18:403-405
[7]蔡秀军,陈健达等,腹腔镜胆未切除术胆管损伤的危险因素分析[J].中华普通外科杂志,2005,20,6:347-349
[8]曾毅克,王存川,腔镜乳腺癌手术的现状和进展[J].中华外科杂志,2004,42,20:1262-1263
[9]张逊,韩兴鹏,徐医军,腹腔镜在停产外科中的应用[J].中华外科杂志,2005,43,6:400-402
[10]季晓昕,骆成玉,腔镜技术在乳腺疾病中的应用[J].中国普外基础与临床杂志,2004,11:213-215
[11]杨甲梅.原发性肝细胞癌[M].实用肝脾外科学.第1版.科学研究出版社,2003.232-285
[12]Shimada M,Hashizume M,Maechara S,et al.Laparoscopic hepatectomy for hepatocellular carcinoma.Surg Endosc,2001,15:541-544
[13]Biertho L,Waage A,Gagner M.Laparoscopic hepatectomies.J Ann Chir,2002,127:164-170
[14]Antonetti MC,Killelea B,Orlando ⅢR.Hand-assisted laparoscopic liver surgery.Arch Surg,2002,137:407-412
[15]Fong YM,Jarnagin W,Conlon KC,et al.Hand-assisted laparoscopic liver resection,Arch Surg,2000,135:854-859
[16]牟一平,朱一平,徐晓武,等.腹腔镜胰腺囊肿切除术2例[J].中国实用外科学杂志,2002,22:634
[17]Park A,Schwartz R,Tandan V,et al.Laparoscopic pancreatic surgery.Am J Surg,1999,177:158-163
[18]Cuschieri A,Frank TG,Brown S,et al.A new multitool for hand-assisted advanced laparoscopic surgery(HALS).M Surg Endosc,2003,17:1368-1371
[19]Targarona EM,Gracia E,Rodriguez M,et al.Hand-assisted laparoscopic surgery.Arch Surg,2003,138:133-141
[20]Gigot JF,Glineur D,Santiago Azagra J,et al.Laparoscopic liver resection for malignant liver tumors:preliminary results of a multicenter European study.Ann Surg,2002,236:90-97
[21]Ker CG,Chen HY,Juan CC,et al.Laparoscpic subsegmentectomy for hepatocellular carcinoma with cirrhosis.Hepatogastroenterology,2000,47:1260-1263
[22]王锐华,刘荣,周宁新,等.腹腔镜肝切除16例临床分析[J].中国微创外科杂志,2003,3:473-475
[23]Keulemans YC,Bergman JJ,de-Wit LT,et al.Improvement in the management of bile duct injuries[J].Am Coll Surg,1998;187(3):246
[24]Ihasz M,Hung CM,Regoly MJ,et al.Complications of laparoscopic cholecystectomy in hungary:a multicentre study of 13833 patients.Eur J Surg,1997;163(4):267
[25]Najnigier B,Zieniewicz K,Nyckowski P,et al.Complication of laparoscopic cholecystectomy.Wiad Lek,1997;50(1):218
[26]Boutelier P.Complications of laparoscopiccholecystectomy:evaluation study.Bull Acad Natl Med,1998;182(3):617
[27]Torkington T,Pereira J,Chalmers RT,et al.Laparoscopic cholecystectomy,bile duct injury and the British and Irish surgeon.Ann R Coll Surg Engl,1998;80(2):119
[28]Merrie AE,Booth MW,Shah A,et al.Bile duct imaging and injury:a regional audit of laparoscopic cholecystectomy,Aust N Z J Surg,1997;67(10):706
[29]Adamsen S,Hansen DH,Funch JP,et al.Bile duct injury laparoscopic cholecystectomy:a prospective nationwide series.J Am Coll surg,1997;184(6):571
[30]Macfadyen BV,Vecchio R,Ricardo AE,et al.Bile duct injury after laparoscopic cholecystectomy:the united states experience.Surg Endosc,1998;12(4):315
[31]黄志强著.黄志强肝胆外科手术学[M].北京:人民军医出版社,1997:233
[32]陈训如主编.腹腔镜手术的并发症与对策[M].昆明.云南科技出版社,1997:128
[33]黄志强主编.当代胆道外科学[M].上海:上海科学技术文献出版社,1998:648
[34]钱光相,吴孟超,张永杰,等.腹腔镜胆囊切除术胆道损伤的类型及原因分析[J].中华外科学杂志,1995;33(11):647
[35]沈立荣,何志军.高位胆管狭窄处理原则及炎性胆管狭窄整形修复[J].实用外科学杂志,1993;13(1):9
[36]王跃文,李立波,黄金文,等.腹腔镜脾切除术[J].中国内镜杂志,1997;3(6):5
[37]Decker Mlllat B,Guillon F,et al.Laparoscopic splenectomy for benign and malignant hematologic diseases:35 consecutive cases.World J Surg,1998;22(1):62
[38]Schlinkert R,Teotia SS.Laparoscopic splecectomy.Arch surg,1999;134(1):99
[39]Rege RV,Merrian LT,Joehl RJ.Laparoscopic splenectomy.Surg Clin North Am,1996;76(3):459
[40]Tanoue K,Hashizume M,Morita M,et al.Results of laparoscopic splenectomy for immune thrombocytopenic purpura.Am J Surg,1999;177(3):222
[41]Okamoto M,Okamoto HK,Tahara F,et al.Ultrasonographic evidence of association of polyps and atones with gallbladder cancer.Am J Gastroenterol,1999,94(2):446
[42]Collett JA,Allan RB,Chisholm RJ,et al.Gallbladder polyps:pro-spective,study. J Ultrasound Med,1998,17(4):207
[43]Chen CY,Lu CL,chang FY,et al.Risk factors for gallbladder polypsin Chinese population.Am J Gastmenterol,1997,92(11):2066
[44]Chen CY,LU C1,Lee PC,et al.The risk factors for gallstone disease among senior citizens:an oriental study.Hepatogastroentemlogy,1999,46(2):1607
[45]Shinchi K,Kono S,Honjo S,et al.Epidemiology of gallbladder pol-yps:an ultrasonographic study of male self-defense officials in Ja-pan.Scand J Gastroenterol,1994,29(1):7 Segawa K,Arisawa T,Niwa Y,et al.Prevalence of gallbladder polyps among apparently health Japanese:ultrasonographic study.Am J Gastroenterol,1992,87(5):630
[46]Csendes A,Burgos AM,Csendes P,et al.Late follow-up of polypoid lesions of the gallbladder smaller than 10mm.Ann Surg,2001,234(5);657
[47]Kubota K,Bandai Y,Noie T,et al.How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystecto-my? Surgery,1995,117(5):481
[48]杨汉良.胆囊息肉样病变的诊断与手术指征,中国实用外科杂志,1995,15(1):18
[49]Shinkai H;Kimura W,Mato T.Surgical indication for small polypoiesions of the gallbladder.Am J Surg,1998,175(2):114
[50]田伏洲,王孝华,张鸣山,等.胆囊胆固醇沉着病的临床治疗.中国实用外科杂志,1995,15(1):21
[51]Edelman DS.Carcinoma of a gallbladder polyps:treated by laparo-acopic laser cholecystectomy.Surg Iapamsc Endosc,1993,3(2):142
[52]Liu ZH,Zhang XH.40例胆囊息肉样病变的形态学分析及其临床意义.中华病理学杂志,1991,20(4):274
[53]Koga A,Watanabe K,Fukuyama.,et al.Diagnosis and operative indi-cation of polypoid lesions of the gallbladder.Arch Surg,1998,123(1);26,
[54]Smok G,Bantjerodi R,Csendes A.Benign polypoid lesions of the gallbladder:their relation to gallbladder adenocarcinoma.Rev MedChil,1992,120(1):31
[55]Sugiyama M,Atomi Y,Yamato T.Endoscopic ultrasonography for differential diagnosis of polypoid gallbladder lesions:analysis in sur-gical and follow up series.Gut,2000,46(2):250
[56]Gouma DJ.When are gallbladder polyps malignant? HPB Surg,2000,11(6);428
[57]王秋生,黄筵庭.胆囊息肉样病变的特点与手术时机.中国实用外科杂志1995,15(1):9
[58]王秋生,黄筵庭.胆囊息肉样病变的特点与手术时机.中国外科专家经验文集.沈阳:沈阳出版社,2000.926
[59]Terzi C,Sokmen S,Secdin S,et al.Polypoid lesions of the gallblad-der:report of 100cases with special reference to operative indica-tions.Surgery,2000,127(6);622
[60]Yeh CN,Jan YY,Chao TC,et al.Laparoscopic cholecystectomy for polypoid lesions of the gallbladder:a clinicopathologic study.Surg Laparosc Endsc Percutan Tech,2001,11(3):176
[61]邓绍庆,周孝思,张武,等.胆囊息肉样病变中肿瘤和癌前病变的识别.中国外科专家经验文集决沈阳:沈阳出版社,2000.922
[62]吴金生,何显力,高德明,等.胆囊息肉样病变109例分析,中国实用外科杂志;2000,20(2):104