经皮胆镜碎石清除术的术式及适应证  

Modified percutaneous cholecystolithotripsy and its indications

作　　者：杨五计[1] 胡安国[1] 李志伟[1] 鲁广恩[1] 胡三元[2] 

机构地区：[1]济南铁路局中心医院普外科 [2]山东医科大学附属医院普外科

出　　处：《中华普通外科杂志》2001年第6期328-330,共3页Chinese Journal of General Surgery

摘　　要：目的　改良现行的经皮胆镜碎石清除术 ,以提高手术成功率 ,并探讨手术适应证。方法　以自制的手术器械和改良的开放法在腹腔内完成常规碎石方法不能完成的胆囊结石患者的治疗。对 12 0例术后患者进行 3～ 36个月随访 ,了解胆囊结石的复发情况。结果　全组 2 91例患者手术成功 2 87例 (98 6 % ) ,其中以改良的开放法完成 99例 (34 5 % ) ,其术后恢复情况与常规手术法无差异。对其中 12 0例进行术后随访 ,3～ 36个月复发 16例 (13 3% )。结果提示 ,胆囊结石数超过 3枚及胆囊功能不良者复发率高于胆囊结石数少于 3枚及胆囊功能正常者。结论　经皮胆镜碎石清除术经术式改良可有效地提高手术成功率。对结石数高于 3枚及胆囊功能不良者应从严掌握手术指征。Objective To improve the traditional percutaneous cholecystolithotripsy in order to elevate the success rate and to discuss its indications. Methods With selfmade apparatus, we modified the open procedure which is otherwise impossible in removing the stones. We have followed 120 patients for 3 to 36 months to look into the recurrence of cholelithiasis. Results We have succeeded in 287 operations in a total of 291 (98 6%) cases. Among which 99 cases (34 5%) received modified open procedures, and the postoperative course was all uneventful. 120 patients were followed up postoperatively from 3 to 36 months and the stone recurrence rate was 13 3% (16 cases). Statistical analysis showed that the stone recurrence rate in patients with 3 stones and up, or poor gallbladder function was significantly higher than those with less than 3 stones and or good gallbladder function.Conclusions The percutaneous cholecystolithotripsy with improved procedures can effectively increase the success rate of operation. According to our result the indications should be restricted to those with less than 3 stones and or with good gallbladder functions.

关 键 词：胆结石 碎石术 内窥镜外科手术 

分 类 号：R657.42[医药卫生—外科学]