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1.
腹腔镜胆囊切除术(LC)日趋普及,手术适应症逐渐扩大。我院自1997年开展LC以来,对21例胆囊结石嵌顿完成了LC,报告如下: 1 临床资料 一般资料:本组21例,女19例,男2例,年龄28-63岁,结石嵌顿并发胆囊炎3例,慢性胆囊炎18例(其中胆囊积脓型4例)。术后住院24-48小时,无胆汁瘘及腹腔内感染发生,无手术后死亡病例。 手术方法:常规四孔法进入腹腔,胆囊因结石嵌顿积液肿大,内压增高,为了便于无创  相似文献   

2.
老年人急性胆囊炎急诊腹腔镜胆囊切除术时机探讨   总被引：1，自引：0，他引：1  
目的：探讨老年人急性胆囊炎急诊腹腔镜胆囊切除术（LC）的可行性及时机。方法：回顾分析86例65岁以上老年人急性胆囊炎急诊LC的临床资料。结果：成功完成LC83例,中转开腹3例,中转开腹率3.49%;无肝外胆管损伤等严重手术并发症发生。发病48h内行LC42例,全部完成LC,无手术并发症;发病48-72h行LC24例,中转开腹1例,术后并发毛细胆管漏1例;发病72h以上行LC20例,中转开腹2例,术后并发毛细胆管漏2例,一过性黄疸2例,全身皮下气肿2例,并发症发生率为30%。全组患者均痊愈出院。结论：老年人急性胆囊炎经合理围手术期处理可安全完成LC,发病48h内行LC成功率高。LC较开腹手术更易治疗伴发病。  相似文献   

3.
目的：探讨腹腔镜胆囊切除术与开放胆囊切除术治疗胆囊结石的临床疗效。方法：选择2010年1月至2013年7月收治的胆囊结石患者共90例作为研究对象,按照治疗方式将其分为腹腔镜胆囊切除术（LC）组和开腹胆囊切除术（OC）组,比较两组患者疗效。结果：LC组手术时间、术中出血量、抗生素使用时间、胃肠功能恢复时间以及住院时间等围手术期指标均明显优于OC组（P〈0．05）;LC组并发症发生率为0．1％,OC组并发症的发生率3％,LC组并发症的发生率明显低于OC组（P〈0．05）。结论：腹腔镜胆囊切除术治疗胆囊结石术中出血少,术后恢复快,住院时间短,是一种安全可靠的治疗方式。  相似文献   

4.
腹腔镜胆囊切除术(Laparoscopic Cholecystecto-my,LC)已成为治疗胆囊良性病变的金标准[1]。其具有创伤小、患者痛苦小、住院时间短、脏器功能恢复快等优点,但如何对腹腔镜胆囊切除术中复杂胆囊情况进行处理,以尽可能减少手术创伤和术后并发症是行LC时所必须面临的问题,现将我院经验总结如下。1资料及方法1.1一般资料本组64例,男23例,女41例。年龄32~76岁,中位数49.5岁。平诊手术27例(42.2%),其中慢性结石性胆囊炎12例,胆囊隆起性病变5例,萎缩性胆囊炎10例;急诊手术37例(57.8%),均为胆囊结石并急性化脓性或坏疽性胆囊炎。1.2手术处理1.2.1出血:⑴胆囊动脉脆性大、易断裂:分离胆囊动脉时拉断3例,胆囊动脉上的钛夹脱落1例。处理:分离胆囊动脉时不过分强调血管骨骼化,分离时尽量贴近胆囊,断裂后及时补夹钛夹;⑵胆囊动脉变异:双胆囊动脉3例,解剖变异4例。处理:因胆囊动脉走行变异,胆囊动脉远段走行在胆囊壁上,应靠近胆囊壁处结扎;⑶胆囊床出血:急性炎症毛细血管扩张,肝硬化时胆囊床有小血管出入肝实质,多有明显渗血,部分渗血在胆囊取出后自止,部分渗血用电灼止血;肝硬化渗血明...  相似文献   

5.
护理干预对老年腹腔镜胆囊切除术患者生理和心理的影响   总被引：1，自引：0，他引：1  
目的：研究护理干预对老年腹腔镜胆囊切除术（LC）患者生理和心理的影响。方法：将60例老年LC患者随机分为干预组和对照组各30例。对照组给予常规护理,干预组在此基础上给予针对性护理干预。比较两组患者入院后、手术前30min的肛温、心率、平均动脉压,紧张焦虑发生率及对护理工作的满意度情况。结果：干预组患者手术前30min肛温、心率、平均动脉压、紧张焦虑发生率低于对照组（P〈0.05）,满意度比较高于对照组（P〈0.05）。结论：LC围手术期应用护理干预,对稳定老年患者生理及心理环境具有积极作用。  相似文献   

6.
本文报告了我院自1997年11月至1998年5月作腹腔镜胆囊切除82例取得成功,并进行了分析。认为只要有设备条件,术者具有独立处理开腹胆道手术能力及经LC培训、严格掌握适应症、二级省市医院开展这一新技术是可行的。  相似文献   

7.
1882年德国Langenbach在T型切口下完成了第一例胆囊切除术,经过后人的发展完善,形成了经典胆囊切除术(Clnssic Cholecystectomy,CC)[1]。随着科技的飞速发展,医学技术水平也日新月异,近20年来先后出现了小切口胆囊切除术(Minilaparotomic Cholecystecto-my,MC),腹腔镜胆囊切除术(Laparoscopic Cholecys-tectony,LC),使微创观念深入人心,并成为现代外科手术的发展方向,但腹腔镜胆囊切除术仍有许多不足之处,如必须全麻,人工气腹和昂贵的仪器设备,手术风险大、费用高[2]。作者通过改进和自制部分手术器械开展小切口胆道手术898例,操作简…  相似文献   

8.
腹腔镜胆囊切除术(LC)在我国已经广泛开展,由于该手术具有创伤小,患者住院天数缩短,相应手术费用降低等优点,被越来越多的患者认可。对于麻醉者来说,因该手术需在二氧化碳气腹下才能完成,麻醉具有一定的特殊性,笔者在北京大学第三医院研修期间对36例腹腔镜下行胆囊切除术的麻醉进行了总结,现报道如下。 1 临床资料 1.1 一般资料 择期行腹腔镜胆囊切除术的患者36例,其中男女各18例,年龄30～45岁,ASAⅠ～Ⅱ级,  相似文献   

9.
腹腔镜胆囊切除术中转开腹对机体免疫反应的影响   总被引：1，自引：0，他引：1  
目的:对比腹腔镜胆囊切除术(LC)中转开腹与开腹胆囊切除术(OC)对机体炎症反应的影响.方法:检测LC中转开腹与OC术前、术后1h,术后1天、3d、5d的外周血T淋巴细胞亚群、WBC计数、C反应蛋白及白介素-6(IL-6)的变化及切口长度,手术、麻醉时间的对比研究.结果:OC组术后1h、1d、3dWBC计数、CRP、IL-6均较术前明显升高,且与LC中转组比较,OC组仍较LC中转组稍高,二者无统计学意义.而OC组术后1h、1d、3d成熟T淋巴细胞(CD3),辅助性T淋巴细胞(CD4),CD4/抑制性T淋巴细胞(CD8)比值较术前下降(P<0.05).且同LC中转组比较,OC组较LC中转组略低,二者仍无统计学意义.但5d后二者以上各项指标均接近正常.结论:LC中转开腹对机体免疫反应影响较OC组并没有增大,技术运用适当,对机体术后恢复等同或略优于传统OC.  相似文献   

10.
腹腔镜及大小切口胆囊切除术对体温影响的对比分析   总被引：2，自引：0，他引：2  
目的：比较经腹腔镜胆囊切除术（LC）、小切口胆囊切除术（MC）、传统的胆囊切除术（OC）对机体体温的影响。方法：对90例良性慢性胆囊疾病，择期在全麻下行胆囊切除的患者随机分为LC组30例，MC组30例，OC组30例，记录术晨、术毕、术后1－3d晨监测的体温。结果：体温升高从术毕至术后3d，LC组小于MC组（P＜0．05），MC组小于OC组（P＜0．01）。结论：从创伤程度与术后体温恢复角度看，LC优于MC，MC优于OC。  相似文献   

11.
Objective: To evaluate the benefit of intraoperative ERCP and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in the treatment of cholelithiasis with choledocholithiasis. Methods: Fifty-two patients with cholelithiasis and choledocholithiasis (as determined by intraoperative cholangiography) were randomly divided into 2 groups during LC. In group A (27 patients), common bile duct stones were extracted by intraoperative EST during LC. In group B(25 patients), common bile duct (CBD) stones were extracted by conversion to open CBD exploration and cholecyctectomy. Results: The success rate was 26/27 (96.3%) in group A and 25/25 (100%) in group B (0.25<P<0.5); The mean postoperative hospitalization was 3.32±0.56 days in group A and 17.5±4.61 days in group B (P<0.001). In group A, two cases were complicated transient hyperamylasemia after the combined procedure. In group B, one case of bile leakage and one case of duodenal ulcer occurred after conversion to open cholecystectomy with CBD exploration. There were no retained stones in group A but 2 cases in group B. Conclusion: Intraoperative ERCP and endoscopic sphincterotomy combined with LC for treatment of cholelithiasis and chiledochlithiasis is safe, effective and results in shorter hospitalization and fewer complications than traditional open cholecystectomy with CBD exploration.  相似文献   

12.
The flipped classroom (FC) model has emerged as an innovative solution to improve student‐centered learning. However, studies measuring student performance of material in the FC relative to the lecture classroom (LC) have shown mixed results. An aim of this study was to determine if the disparity in results of prior research is due to level of cognition (low or high) needed to perform well on the outcome, or course assessment. This study tested the hypothesis that (1) students in a FC would perform better than students in a LC on an assessment requiring higher cognition and (2) there would be no difference in performance for an assessment requiring lower cognition. To test this hypothesis the performance of 28 multiple choice anatomy items that were part of a final examination were compared between two classes of first year medical students at the University of Utah School of Medicine. Items were categorized as requiring knowledge (low cognition), application, or analysis (high cognition). Thirty hours of anatomy content was delivered in LC format to 101 students in 2013 and in FC format to 104 students in 2014. Mann Whitney tests indicated FC students performed better than LC students on analysis items, U = 4243.00, P = 0.030, r = 0.19, but there were no differences in performance between FC and LC students for knowledge, U = 5002.00, P = 0.720 or application, U = 4990.00, P = 0.700, items. The FC may benefit retention when students are expected to analyze material. Anat Sci Educ 10: 170–175. © 2016 American Association of Anatomists.  相似文献   

13.
Gough and Tunmer’s (1986) simple view of reading (SVR) proposed that reading comprehension (RC) is a function of language comprehension (LC) and word recognition/decoding. Braze et al. (2007) presented data suggesting an extension of the SVR in which knowledge of vocabulary (V) affected RC over and above the effects of LC. Tunmer and Chapman (2012) found a similar independent contribution of V to RC when the data were analyzed by hierarchical regression. However, additional analysis by factor analysis and structural equation modeling indicated that the effect of V on RC was, in fact, completely captured by LC itself and there was no need to posit a separate direct effect of V on RC. In the present study, we present new data from young adults with sub-optimal reading skill (N = 286). Latent variable and regression analyses support Gough and Tunmer’s original proposal and the conclusions of Tunmer and Chapman that V can be considered a component of LC and not an independent contributor to RC.  相似文献   

14.
Enabling pre-service teachers to develop a critical view of their practice and to acquire the higher order inquiry skills necessary for pedagogic research has been and continues to be a challenge. The present study presents a unique intervention in the training of pre-service teachers in research literacy (RL) skills using a Problem Based Learning (PBL) approach. The intervention is implemented in two different Learning Communities (LC), one online and the other blended. Both immediate and long-term effects of PBL are investigated as are the effects of social and direct scaffolding within the LCs. The study focuses on transmitting the following RL skills: identifying and defining a problem, formulating a research question, and designing a research method. The findings indicate an immediate effect upon all RL skills in both LCs. The long-term effect appears only in the online LC and only for two RL skills: identifying and defining problems. Additionally, there is greater use of social scaffolding in formulating and designing a research study in the online LC than in the blended learning community. Those findings are then interpreted in terms of retention capacity and scaffolding in blended and online LCs.  相似文献   

15.
ABSTRACT

Nursing Assistants (NAs) are the largest workforce in nursing homes, but often lack adequate preparation for their role. The Living Classroom (LC) is an integrated learning approach, whereby a NA program is delivered in a nursing home (NH) in collaboration with a community college. This paper describes the implementation and evaluation of the LC. Mixed methods were used to gather data from 48 NA students, 5 faculty, and 42 NH staff over 30 weeks. Students, faculty, and nursing home staff described the LC as a positive learning experience. Students’ gerontological knowledge increased over time (p = .0012). Students reported very positive relationships with program mentors and NH residents. The LC provides a unique approach to prepare NAs to work in nursing homes. This model could expand to other educational programs with a gerontology focus.  相似文献   

16.
This study investigated the effects of three instructional conditions on precursors to successful reading for Spanish‐speaking English language learners (ELL). The study was conducted using a randomized, alternate treatment control group design specifically targeting phonological awareness (PA) listening comprehension (LC), and decoding in a sample of ELL (N= 82) including students who were and were not at risk for later reading failure. Two randomly assigned experimental intervention groups and one treatment control group were created to test the effectiveness of three instructional interventions that differed in the relative amount of time used for instructing the word‐ and text‐level targeted skills. Specifically, the two experimental intervention groups received different doses of LC relative to PA instruction, creating a LC Concentration group and a PA Concentration group. The treatment control group received only PA and alphabet knowledge instruction (word‐level skills). Results indicated that both at‐risk and not‐at‐risk ELLs in the LC Concentration group outperformed students in the other groups on almost all measures, including PA skills, despite minimal amounts of instructional time‐targeting word‐level skills. These data extend the existing literature by lending empirical support to the use of a LC component in early reading interventions for young ELL.  相似文献   

17.
Familiarity with the strategies of Academic Corruption (AC) strengthens meritocracy values, increases participation, and education quality calls for the proper use of policies and cultural values ​​by the higher education system. The purpose of this study was to examine the effect of lean culture (LC) on reducing AC with the mediation of positive organizational politics (POP). Statistical population of this research included faculty members of University of Sistan and Baluchestan, Iran. The method of this study was correlational, and it was conducted on faculty members of University of Sistan and Baluchestan with a sample of 185 people based on stratified random sampling method. The research tools included three questionnaires of lean culture questionnaire adapted from Maciąg model (Maciąg, 2019b), positive organizational policy questionnaire adapted from Kacmar and Carlson (1997); Nye and Witt (1993), & Sen et al. (2018) models and the researcher-made questionnaire of reduction of academic corruption adapted from Tierney and Sabharwal (2017) model. According to the findings, confirmatory validity, composite reliability, and Cranbach's alpha were reported to be appropriate in all the three tools. The analysis method was using Partial Least Squares (SmartPLS). The results showed that LC directly and indirectly was effective in reducing AC through POP. Moreover, LC had a direct effect on POP and POP had a direct effect on AC reduction. It could be stated that lean values besides positive organizational policy could play a constructive role in reducing AC; and reducing AC is somehow connected to cultural and political factors of higher education.  相似文献   

18.
Meat quality traits of four genotypes of Chinese indigenous chicken [Ninghai chicken (NC), frizzle chicken (FC), Ninghai xiang chicken (XC), and Zhenning loquat chicken (LC)] and one genotype of commercial broiler [Arbor Acres plus broiler (AAB)] were analyzed. The indigenous chickens were raised before the commercial chickens in order to achieve the same final processed days. Indigenous chickens of NC, FC, XC, and LC showed significantly higher inosine-5′-monophosphate (IMP) content, shorter fiber diameter, and lower shear force than those of AAB (P<0.05). In the indigenous genotypes, NC and FC had significantly shorter fiber diameters and lower shear forces than XC and LC (P<0.05), and NC and XC had a higher IMP content than FC and LC (P<0.05). Moreover, the indigenous genotype of LC significantly displayed the highest protein content (P<0.05) in the five genotypes of birds, and no significant differences of protein content were found between the other genotypes of NC, FC, XC, and AAB (P>0.05). The indigenous chickens from FC displayed the highest total lipid content in the five bird genotypes (P<0.05). Significant differences of pH, color values of L* and a*, and drip loss for the five genotypes of birds were also observed. In conclusion, there were significant differences in the meat quality traits of the bird breeds selected in this study, and the indigenous chickens, especially the NC genotype, produced better quality meat as far as the IMP content, fiber diameters, and shear forces were concerned.  相似文献   

19.
目的：探讨内镜下0ddi括约肌切开取石术（endoscopic sphincterotomy,EST）联合腹腔镜胆囊切除术（1apanroscopic cholecystectomy,LC）治疗胆囊结石合并继发性胆管结石的疗效。方法：对21例胆囊结石合并继发性胆管结石患者先行EST术,再行LC术。结果：21例均完成EST和LC术,其中1例患者LC术后经胆道造影见胆总管结石残留,再次行EST术。结论：EST联合LC治疗胆囊结石合并继发性胆管结石是一种安全有效的微创治疗模式。  相似文献   

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