腹腔镜胆囊部分切除术在治疗胆囊结石及腺瘤样息肉中的应用(附12例报告)  

Laparoscopic partial cholecystectomy for cholecystolithiasis and adenomatous polyp:with a report of 12 cases

作　　者：梁法生[1] 张晓微[1] 夏冬雪[1] 刘福全[1] 谢家祺[1] 

机构地区：[1]大连大学附属新华医院,辽宁大连116021

出　　处：《腹腔镜外科杂志》2009年第6期438-440,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜胆囊部分切除术在治疗胆囊结石及腺瘤样息肉中的应用价值。方法:2006年3月至2009年1月我院为7例胆囊结石、5例胆囊腺瘤样息肉患者行腹腔镜胆囊部分切除术。胆囊结石患者胆囊底部萎缩,体部和颈部壁略厚,有较轻的慢性炎症。切除胆囊底部,胆道镜检查取净结石,用3-0可吸收线两层缝合胆囊。胆囊息肉患者息肉基底较宽,腹腔镜下切开胆囊体部前壁约1.5cm,用胆道镜找到腺瘤,延长胆囊切口充分显露腺瘤,直视下将腺瘤及其基底部相连的胆囊壁一并切除,术中病理报告均为良性腺瘤,同法缝合胆囊。结果:患者均治愈,手术时间90～130min,平均(114±13)min;肛门排气时间24～30h,平均(26.6±2.1)h;无胆漏及其他并发症发生,术后6d痊愈出院,术后随访1～28个月,胆囊结石和胆囊息肉患者的胆囊收缩功能分别为15%～35%、30%～50%。结论:完全腹腔镜联合胆道镜行胆囊部分切除术治疗胆囊结石和腺瘤样息肉,对保护胆囊及胆囊功能具有重要意义,在部分病例中是可行的,是一种新的保胆术式。Objective ： To discuss the application and value of laparoscopie partial cholecystectomy in the treatment of cholecystolithiasis and adenomatous polyp. Methods：From Mar. 2006 to Jan. 2009 7 patients with eholecystolithiasis and 5 patients with adenomatous polyp underwent laparoscopic partial cholecystectomy in our hospital. The atrophic bottom of gallbladder was found in patients with cholecystolithiasis,and complicated chronic little-inflamed body and neck of gallbladder,whose wall was thick. The bottom of gall- bladder was removed, then all the stones were removed by choledochoseope, gallbladder was two-layeredly sutured with 3-0 absorbable line. A incision as long as 1.5cm was made on the front wall of gallbladder body in patients with polyps, adenomatous polyp was found by choledochoscopy. The incision was extended so that adenomatous polyp with broad fundus was exposed clearly. The polyp and the wall of gallbladder attached to it were removed together. After pathologic result was known that the polyp was benign, the incision of gallbladder was sutured as mentioned above. Results：All the patients were cured. The operation time was 90-130（ 114 ± 13 ）min ;Postoperative exsufflation time was 24-30 （26.6 ± 2.1 ）h. The postoperative hospital stay was 6 days. Bile leakage and other complications hadn＇t occurred. In the follow-up of 1 to 28 months, the contractibility of gallbladder in patients once had gotten choleeystolithiasis was 15%- 35% and 30%-50% in patients once had adenomatous polyp. Conclusions： The laparoscopic partial cholecystectomy combined with choledochoscopy in the treatment of cholecystolithiasis and adenomatous polyp is meaningful for protecting gallbladder and cystic function. It is feasible for some patients and a new surgery for preservation of gallbladder.

关 键 词：胆囊部分切除术 腹腔镜术 胆囊结石 腺瘤样息肉 病例报告 

分 类 号：R657.4[医药卫生—外科学]