Objective:To investigate the effect of virtual-simulation laparoscopic training system in the training of basic skills of endoscopic surgery in trainees with different clinical experience.Method:s Eight refresher physicians, eight residents who received standardized residency training, and eight undergraduate interns in five-year clinical medicine were selected. All of them received the training of endoscopic operations with the laparoscopic training box and the virtual-simulation laparoscopic training system for 30 minutes every day for 4 weeks. Data analyses were performed using SPSS 19.0 and t-test was adopted to compare the scores before and after training among the three groups.Result:s Before training, there were significant differences in endoscopic operations between the undergraduate intern group and the other two groups ( P<0.05); after 4 weeks of training, all three groups had significant increases in the scores and spent less time on training items ( P<0.05). There was no significant difference in simple operations among the three groups ( P>0.05), and the undergraduate intern group had a significantly higher score of complex operations than did the standardized residency training group and the refresher physician group ( P<0.05). Conclusion:The virtual-simulation laparoscopic training system can improve the laparoscopic skills of clinical trainees at different levels, therefore, it is worth being promoted in the teaching of clinical skills.

①目的探讨老年急性胆囊炎患者早期实施腹腔镜胆囊切除术的围手术期处理。②方法选取我院2013年1月～2015年10月收治的老年急性胆囊炎患者120例，按患者的意愿分为急诊手术组60例和早期手术组，60例。患者年龄均＞60岁。急诊手术组于入院8小时内手术；早期手术组先进行围手术期处理，病情稳定后48小时之内实施手术。比较两组患者术中出血量、术后肠蠕动恢复时间、手术时间、总住院时间、住院费用及术后并发症发生率。③结果两组患者术中出血量、术后肠蠕动恢复时间差异无统计学意义（P ＞0．05）；早期手术组患者手术时间、总住院时间、住院费用、术后并发症发生率均优于急诊手术组，差异具有统计学意义（P ＜0．05）。④结论合理掌握手术适应证，老年急性胆囊炎患者经积极完善的围手术期处置后早期实施腹腔镜胆囊切除术是安全、有效的。

Objective To evaluate duodenal endoscopy combined with laparoscopy treatment for choledocholithiasis and cholelithiasis in old patients.Methods 56 old patients suffered from choledocholithiasis and cholelithiasis were divided into two groups.28 patients in ERCP + EST + LC group were treated with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and laparoscopic cholecystectomy(LC),while 28 patients in control group were treated with open cholecystectomy and choledochotomy with T tube drainage.Common bile duct diameter,stone size,stone number in common bile duct,operation time,gastrointestinal function recovery time,complication rate,hospitalization time and cost were observed and analyzed.Results There was no statistical difference in common bile duct diameterand stone size and numbers.Compared with control group,operation time,gastrointestinal function recovery time,complication rate and hospitalization time were decreased(P<0.05,P<0.01) while the hospitalization cost were increased(P < 0.01).Conclusion The combined application of ERCP/EST and LC is effective and feasible in the treatment of cholangitis with choledocholithiasis and cholelithiasis in old patients.It has so many advantages such as better effect,less trauma,rapider recovery;and shorter length of hospitalization.

Aim To probe into laparoscopic cholecystectomy(LC) and transfer the experience of convert to open procedure.Methods Review and analyse that 31 cases and convert to open procedure among 1 430 LC patient's clinical materials from January of 2006 to December of 2008 of our academy.Results The overall conversion rate was 2.71%(31 patients),The operative complications included abdominal cavity internal bleeding in 4 patients,bile duct injury in 2 cases,intestinal injury in 1 cases,disturbed anatomy and adhesion in the region of the Calots' triangle in 20 cases,carcimoma of gallbladder of 1 cases,suspect choledocholith in 12 cases.Without operation complication,31 follow up a case by regular visits to and has not unusually found in half a years.Conclusion The appropriate choice of operative indication,being familiar with the anatomic structure of Calot's triangle and conversion to open surgery if necessary is the key of operative success.