硬性输尿管肾镜在微创保胆取石(息肉)术中的运用  

Application of the rigid ureteropyelosecopy in minimally invasive surgery for stone extraction with gallbladder preserved

作　　者：杨昌勋[1] 刘衍民[2] 苏华斌[1] 王佳兴[1] 唐民[1] 

机构地区：[1]湖南省怀化市中医院外科,湖南怀化418000 [2]广州医学院第一附属医院微创中心,广东广州510230

出　　处：《中国内镜杂志》2010年第6期616-618,621,共4页China Journal of Endoscopy

摘　　要：目的探讨输尿管肾镜在微创保胆取石(息肉)术中的运用技巧及运用前景。方法 2007年12月～2009年5月,用WOLF或奥林巴斯输尿管肾镜联合腹腔镜行微创保胆取石(息肉)手术287例。采用气管插管全身麻醉或连续硬脊膜外阻滞麻醉,在腹腔镜监视下于右上腹近胆囊底处腹壁切口1.5～2.0cm,将胆囊底提出体外切开1.0cm左右切口,插入F18或F20的peel-away鞘建立经皮胆通道,利用套石篮、气压弹道碎石、灌注泵低压灌注、peel-away鞘推、挤、压,取石钳钳夹等手法。结果 287例患者中283例保胆成功,1例胆囊管内多发结石嵌顿及3例胆囊化脓性炎症而改行胆囊切除。全组无1例并发症发生。随访1～18个月,1例结石复发。结论利用输尿管肾镜联合腹腔镜行微创保胆取石(息肉)手术与硬胆道镜一样简单易行、安全有效,且能完全清除胆囊结石(息肉)。[Objective]To investigate application and prospect of the rigid ureteropyelosecopy in minimally invasive surgery for stone extraction with gallbladder preserved. [Methods]287 patients underwent minimally invasive surgery for stone extraction with gallbladder preserved by using of WOLF or OLYMPUS ureteropyelosecopy companying with laparoscopy in our hospital during the time from December 2007 to May 2009. We operated an incision of 1～1.5 cm length at the right upper abdomen nearby the bottom of gallbladder under supervised of laparoscopy under endotracheal intubation anesthesia or epidural anesthesia. Then we operated an incision of 1 cm length at the bottom of gallbladder and inserted F18 or F20 peel-away in order to set up percutaneous biliary access. [Results]Among 287 cases, 283 cases were successfully treated, 4 cases underwent cholecystectomy because one case had calculus incarcerated cholecystitis in cystic duct and three cases had suppurative cholecystitis. No one had the complications. All were followed up for 1～18 months, one case had stone in gallbladder again.[Conclusions] Ureteropye-losecope companying with laparoscope can simply and safely extract the stone with gallbladder preserved the same as the mini compact nephroscope.

关 键 词：胆囊结石 胆囊息肉 输尿管肾镜 保胆手术 

分 类 号：R657.4[医药卫生—外科学]