微创内镜保胆取石术816例临床分析  

Minimally invasive treatment of gallstones and endoscope kipping the gallbladder intact: clinical analysis of 816 cases

作　　者：徐立友[1] 宋钊[1] 刘钊[1] 战志勇[1] 

机构地区：[1]山东大学附属济南市中心医院肝胆外科,山东济南250013

出　　处：《中国内镜杂志》2010年第12期1297-1299,1302,共4页China Journal of Endoscopy

摘　　要：目的探讨经内镜胆囊取石术治疗胆囊结石的指征及临床价值。方法于右上腹莫菲点处行2～4cm纵形切口,根椐结石大小于胆囊底部无血管区电切开,在胆道镜引导下取出胆囊结石。确认无结石残留并观察到胆汁涌入胆囊后,以灭滴灵冲洗胆囊,胆囊切口用可吸收线全层逢合并荷包包埋,不置胆囊造瘘管和腹腔引流管。结果共收治胆囊结石患者924例,其中816例行经内镜胆囊取石术,均痊愈出院,切口无感染,无并发症。经1～8年随访637例,脂肪餐前后B超对比检查,结果显示胆囊收缩功能良好。其中2例患者术后1个月和4个月B超复查,胆囊为葫芦型,有残余结石,1例行二次内镜取石保胆术。有8例胆囊泥沙样结石患者术后1个月复查B超发现结石复发,仍为泥沙样结石,经口服优思弗3～6个月后结石消失。结论微创内镜取石保胆术治疗胆囊结石疗效理想,创伤小,既保留了有功能的胆囊,又取出了结石。但必须严格掌握适应证,术中必须观察到胆汁自胆囊管口涌入胆囊,否则,中转手术行胆囊切除术。【Objective】To discuss the adaptation and clinical value of mini-cholecystolithotomy remaning gall-bladder for gallstone.【Methods】The up right abdominal Murphy＇s point was choosen for 2～4 cm of length minia-ture longitudinal incision,then an incision was made according to the size of calculus at fundus of gallbladder,the cholecystolithiasis was dislodged under choledochoscope.After clearly removed all stones,gallbladder was washed with Metronidazole,then the incision was closed.【Results】816 of 924 cases of gallbladder stones under choledo-choscope recovered.After follow-up 1～8 years of 637 cases.Ten patients had residue stone in B ultrasound exami-nation,other patients were cured with no infection and complication.Ultrasound was performed in patients to evalu-ate the contractility of gallbladder before and after intake of fatty food,and a normal contractility was revealed.【Conclusion】Minimally invasive choledochoscope treatment can ideally cure gallbladder stone.But the clinical application must be restricted by application.The observation of flow of bile into gallbladder is important for evaluat-ing the result of the operation.

关 键 词：胆囊结石 微创 胆道镜 胆囊切开术 

分 类 号：R657.42[医药卫生—外科学]