ABSTRACT Laparoscopic cholecystectomy is generally performed using 4 ports by transperitoneal access. Recent developments regarding laparoscopic surgery have been directed toward reducing the size or number of ports to achieve the goal of minimally invasive surgery, by minilaparoscopy, natural orifice access, and the transumbilical approach. The aim of this article is to describe our laparoscopic transumbilical cholecystectomy technique using conventional laparoscopic instruments and ports. The Veress needle was placed through the umbilicus, which allowed carbon dioxide inflow. A 5-mm trocar was placed in the periumbilical site for the laparoscope followed by the placement of 2 additional 5-mm periumbilical trocars. The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed, and all 3 periumbilical skin incisions were united for specimen retrieval. Five transumbilical cholecystectomies were performed following this technique. The mean BMI was 26.6 kg/m(2). The mean operative time and blood loss were 46.2 minutes and 55 mL, respectively. No intraoperative complications occurred. Analgesia was performed using dipyrone (1g IV q6h) and ketoprofen (100 mg IV q12 h). Time to first oral intake was 8 hours. Mean hospital stay was 19.2 hours. Laparoscopic transumbilical cholecystectomy seems to be feasible even using conventional laparoscopic instruments and can be considered a potential alternative for traditional laparoscopic cholecystectomy.

目的：比较分析腹腔镜胆囊切除术与开腹胆囊切除术治疗胆结石的疗效。方法本次研究对象为我院2012年6月至2015年6月收治的120例胆结石患者，随机选取60例患者为对照组，并采取开腹胆囊切除术治疗；随机选取60例患者为观察组，并采取腹腔镜胆囊切除术治疗。结果观察组的手术时间、术中出血量、胃肠功能恢复时间、医疗费用、不良反应发生率等观察指标均显著优于对照组（P＜0.05）。结论腹腔镜胆囊切除术治疗胆结石的疗效显著优于开腹胆囊切除术。

Conclusion: Antibiotic prophylaxis is not needed for laparoscopic cholecystectomy.

Routine preoperative antibiotic prophylaxis is not necessary in low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy.

感染是最常见的手术后并发症，抗菌药物在围手术期的正确预防性应用有助于减少手术部位的感染（SSI），即发生在切口或手术深部器官或腔隙的感染。本文将从药物选择、用药时间和用药疗程等方面进行综述，今后要加大抗菌药物的监控与管理力度，以提高抗菌药物预防性使用的合理性。

Abstract BACKGROUND: Fast-track surgery has been described as a plan to facilitate early recovery. We present one surgeon's modifications to fast-track surgery for laparoscopic colectomy patients. METHODS: We performed a retrospective review of 48 consecutive patients undergoing elective laparoscopic colectomy treated by a modified fast-track plan between 2004 and 2008. Elements included preoperative education, pre-anesthesia dexamethasone, immediate postoperative general diet, no urinary catheter, no epidural anesthesia, and no flatus or bowel movement as a discharge requirement. Data collected included the following: age, sex, body mass index, resection indications, surgical time, blood loss, pain score, time to ambulation, time to bowel function, length of stay, complications, and mortality. RESULTS: The mean length of stay was 37 hours (1.5 d), with 29 of 48 patients discharged without passage of flatus or stool. Only 1 patient required readmission. CONCLUSIONS: Our modified fast-track plan achieved significant improvement in length of stay for laparoscopic colectomy compared with previous results. Copyright (c) 2010 Elsevier Inc. All rights reserved.

目的探讨腹腔镜胆囊切除术围术期预防性应用抗菌药物干预措施的效果与可行性。方法设干预组与非干预组进行对照研究，将医院干预前后反映抗菌药物使用情况的各项指标进行对比分析。结果实施干预后，抗菌药物使用基本合理，抗菌药物费用明显下降。结论本研究所实施的干预措施可行、有效，对促进安全、有效、经济使用抗菌药物有积极作用。

Abstract Fast-track surgery or 'enhanced recovery after surgery' or 'multimodal rehabilitation after surgery' is a form of protocolbased perioperative care programme. It is an amalgamation of evidence-based practices that have been proven to improve patient outcome independently and exert a synergistic effect when applied together. The philosophy is to treat the patient's pathology with minimal disturbance to the physiology. Several surgical subspecialties have now adopted such protocols with good results. The role of fast-track surgery in colorectal procedures has been well demonstrated. Its application to other major abdominal surgical procedures is not as well defined but there are encouraging results in the few studies conducted. There has been resistance to several aspects of this programme among gastrointestinal and general surgeons. There is little data from India in the available literature on the application of fast-tracking in gastrointestinal surgery. In a country such as India the existing healthcare structure stands to gain the most by widespread adoption of fast-track methods. Early discharge, early ambulation, earlier return to work and increased hospital efficiency are some of the benefits. The cost gains derived from this programme stand to benefit the patient, doctor and government as well. The practice and implementation of fast-track surgery involves a multidisciplinary team approach. It requires policy formation at an institutional level and interdepartmental coordination. More research is required in areas like implementation of such protocols across India to derive the maximum benefit from them. Copyright 2014, NMJI.

目的：观察快速康复理念（FTS）在急性结石性胆囊炎微创治疗手术中临床应用的效果。方法： 将128例急性结石性胆囊炎患者采用随机数字表法分为快速康复护理组（FTS组）和对照组，各64例。对照组接受常规护理，FTS组接受快速康复护理，观 察比较两组患者的治疗情况。结果：FTS组与对照组比较，进食、下床活动、排气、时间提前，而且术后住院时间短、住院费用显著低，差异均有统计学意义 （P＆lt;0.05），但手术时间无明显差别（P＆gt;0.05）。结论：快速康复外科理念在微创治疗急性结石性胆囊炎的应用上能够降低患者痛苦以及 并发症的发生率，有利于患者及早恢复，缩短住院时间，节省治疗费用。

目的：肝胆外科手术护理使用快速康复护理的研究分析。方法对文献资料进行翻阅，结合实际工作经验来进行研 究分析。结果快速康复护理对患者的手术质量和预后都能起到积极的促进作用，治疗周期缩短，患者经济负担减少。结论快速康复护理在手术治疗的应用将会越来越 广，可以为患者提供更好的医疗服务。

Appropriate patient selection, sensible scheduling of operations and avoiding the use of drains will decrease unplanned admissions following DCLC. Although the time taken to perform procedures was higher for surgical trainees than consultants, this had no adverse outcome on patient outcome.

Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

目的了解湖南省人民医院住院病 人胆道感染细菌分布及其对目前常用抗生素的敏感性。方法对2011年1月1日-2012年6月30日245例胆道疾病患者胆汁培养阳性所检出的280株细 菌及其药敏试验结果进行回顾性分析。结果检出革兰阴性细菌(G-菌)195株(69.6%),其中大肠杆菌78株(27.9%)、肺炎克雷伯菌39株 (13.9%)和铜绿假单胞菌22株(7.9%)分列前三位;革兰阳性球菌(G+球菌)83株(29.6%),其中粪肠球菌29株(10.4%)、屎肠球 菌13株(4.6%)和变异链球菌13株(4.6%)分列前三位;真菌(白色念珠菌)2株(0.7%)。G-菌主要对碳青霉烯类和氨基糖苷类药物敏 感;G+球菌主要对糖肽类、硝基呋喃类和碳青霉烯类药物敏感。结论胆道细菌感染的菌种分布和药敏情况较前均发生了变化,应尽可能作胆汁培养指导临床合理用 药,以减少耐药菌株的产生。

Abstract [This corrects the article DOI: 10.1186/s13017-016-0089-y.].

目的 研究快速康复外科(FTS)在肝胆外科应用的安全性及疗效.方法 我院2010年6月至2012年10月收治的肝胆外科接受不同手术治疗的98例患者随机分成实验组和对照组,对照组围手术期采用传统处理方法,实验组采用FTS围手术期处理方法,术后检测第1、3、5、7天的血清C反应蛋白(CRP)、白介素-6(IL-6)、IgA、IgG、CD4、CD8的阳性细胞值,CD4/CD8的比例,同时术后观察住院时间和术后并发症等指标.结果 实验组术后血清CRP、IL-6、IgA、IgG水平在术后第1、3、5天明显高于对照组,较对照组更快恢复术前的水平；CD4、CD8的阳性细胞值,以及CD4/CD8的比例在术后第1、3、5天明显高于对照组；而且实验组术后住院时间明显缩短,术后并发症与对照组基本一致.结论 FTS应用于肝胆外科术后患者的免疫功能恢复得更快,应激反应较低,有利于患者术后快速的康复,而且是完全安全和有效的.

Although laparoscopic cholecystectomy (LC) is a common and widely applied technique, the use of antibiotics during the perioperative period in infection prevention remains controversial. In our study, a meta-analysis was performed to assess the impact of antibiotic prophylaxis on the postoperative infection rate in LC.A literature search was conducted on studies published between January 1966 and March 2010 that involved LC and prophylactic administration of antibiotics. Only randomized trials that compared perioperative antibiotic prophylaxis with placebo or no treatment in low-risk patients undergoing LC were selected. Eighteen studies qualified according to the inclusion criteria, but only 12 were of adequate quality according to the Jadad scale to be included for the meta-analysis. Data were analyzed via the Peto odds ratio (OR) method and run using RevMan 4.2 software. The precision of the estimation of OR by individual studies was used to calculate their contribution (or weighting) to the pooled OR.The results of the 12 studies did not have significant heterogeneity, and thus, the fixed effect model was used for data analysis. Compared with placebo or no treatment, there was no significant risk reduction in the antibiotic prophylaxis group with regard to overall infections (OR=1.11; 95% confidence interval [CI], 0.68-1.82; P=.67), wound infections (OR=1.07; 95% CI, 0.59-1.94; P=.99), major infections (OR=2.88; 95% CI, 0.3-28.09; P=.36), distant infections (OR=1.01; 95% CI, 0.43-2.36; P=.99), or positive bile cultures (OR=0.76; 95% CI, 0.54-1.08; P=.12). However, prophylactic antibiotics did shorten length of hospital stay (weighted mean difference=-0.16; 95% CI, -0.22 to -0.09; P<.01).Prophylactic antibiotics are not necessary for elective LC in low-risk patients.