ppt课件-laparoscopiccholesectomy-universityofkentucky.pptVIP

LAPAROSCOPIC CHOLECYSTECTOMY CARA LAWRENCEUNIVERSITY OF KENTUCKYCOLLEGE OF MEDICINE Symptoms pain located URQ to upper middle of the abdomen. Pain occurs within minutes of a meal clay colored stools Jaundice (obstructive/conjugated) Nausea Vomiting Mild fever Work up Blood tests: Amylase and Lipase- digestive enzymes made by the pancreas Bilirubin- jaundice (typically measures both BC/BU) CBC Liver function Abdominal Ultrasound Abdominal CT scan Abdominal X-ray Oral cholecystogram -Eat high fat meal at noon, low fat meal at night, take tablets and then NPO until the x-ray the next day Gallbladder radionuclide scan- 1-2 hr scan that takes pictures to detect inflammation or gallstones Useful for detecting gallstones and location Abdominal Ultrasound Example From St. Luke’s Health System Resource Library Diagnosis1 Acute/Chronic cholecystitis: Cholelithiasis -90% of cases often obstruction of the cystic duct, in chronic it is not understood if gall stones are what first initiate symptoms Rarely tumors: cholangiocarcinoma freq: 0.6/100,000 malignancy of the biliary tree Biliary dyskinesia: (chronic acalculous gallbladder disease) Diagnosis1 Cholelithiasis (gallstones)- 10-20% of the population Pigment stones and Cholesterol stones Women 2x more likely to have, aging also plays a role Choledocholithiasis- if gallstone(s) located in the common bile duct From T Laparoscopic Cholecystectomy Low mortality Shorter hospital stay Quicker recovery Decreased cost Gall Bladder or Bile duct tumors Portal Hypertension Acute pancreatitis Biliary fistula Mirizzi’s Syndrome Pregnancy in the final trimester Cardiopulmonary or Coagulation disorders Advantages Contraindications2 Instrumentation 2 or 3 5mm trocars 1 or 2 10mm trocars 10mm 30° scope liver retractor/ grasper(s) straight dissectors clip applier Scalpel and Suture Metzenbaum Scissors L-hook electrocautery 5 mm/10mm, irrigation suction Cholangiogram depending on location of stones extraction