腹腔镜辅助小切口下保胆取石即时缝合术216例报告  

Report on laparoscopy combined tiny incision removal of cholecyst lithiasis with primary closure of cholecyst incision for preservation of cholecyst in 216 cases

作　　者：陈安平[1] 李波[1] 山长星[1] 郭鑫[1] 索运生[1] 刘安[1] 易斌[1] 王征夏[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,成都274300

出　　处：《中华腔镜外科杂志（电子版）》2011年第3期46-49,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜辅助小切口下保胆取石即时缝合术的手术方法和适应证。方法 216例患者在全身麻醉下采用经脐下缘入路腹腔镜辅助探查胆囊和定位,右上腹肋缘下小切口入腹,胆囊底部悬吊、固定和切口,借助取石钳、吸引器、胆道镜、取石网和斑马导丝处理胆囊结石和胆囊管开口。胆囊壁切口用3-0可吸收线间断"8"字缝合或连续扣锁缝合,再用一小束修整过的带血管蒂的大网膜或腹膜缝扎固定于胆囊壁切口处。必要时,Winslow孔附近放置一根16F脑室引流管观察渗漏情况。结果施行腹腔镜辅助小切口下保胆取石即时缝合术216例,成功169例,中转为全腹腔镜下保胆取石即时缝合术32例,中转为腹腔镜胆囊切除术15例。胆漏1例。无残留结石、胆道出血和中转开腹。无死亡。腹腔引流管引流出渗出液10～300ml/d,术后2～6d拔除。手术历时约30～145min,平均约67min。术后住院3～9d。结论只要严格选择合适的患者,确切的胆道镜检查和治疗,可靠精确的缝合和覆盖胆囊壁切口,施行腹腔镜辅助小切口下保胆取石即时缝合术是可行、有效、安全的。此方法可以长期保留有功能的胆囊,以满足部分患者心身健康的需要。Objective The purpose of this paper was to discuss the methods and indications of treating the cholecyst lithiasis by laparoscopy combined tiny incision and choledochoscopy for preservation of cholecyst.Methods A pospective study of 216 patients of treating the cholecyst lithiasis by laparoscopy combined tiny incision and choledochoscopy for preservation of cholecyst had been operated between March 2002 and November 2010.It was first adopted that extraction of the gall bladder stones with choledochoscopy,that the incision of the gall bladder were performed with absorbable suture 3-0（polyglycolic acid bralded suture） by suturing method of primary closure of cholecyst incision.Results It had completed successful cholecyst clerrance to reach the preestablished object of preservation of cholecyst to 169 patients in total 216 patients.It changed laparoscopic combined tiny incision preservation of cholecyst into total laparoscopy preservation of cholecyst in 32 patients.It changed preservation of cholecyst into laparoscopic cholecystectomy in 15 patients.It had leaked the bile juice continue to heal up in 1 patients.No patient had residual stones andthe bleeding of bile duct.No patient died.Conclusions If patients are suitable,this method is safety and feasible that had completed successful cholecyst lithiasis clearance and the incision of the gall bladder were performed with absorbable suture by the primary closure method,it was for preservation of the functional cholecyst.

关 键 词：腹腔镜 胆道镜 保胆治疗 胆囊结石 即时缝合术 

分 类 号：R657.4[医药卫生—外科学]