腹腔镜胆囊部分切除术在保胆中的应用  

Application of with laparoscopic to treat gallbladder disease of preservation cholecyst in partial cholecystectomy

作　　者：梁法生[1,2] 梁杰[1,2] 兰云霞[1,2] 韩爱萍[1,2] 赵昌志 沈慧琳 

机构地区：[1]大连市肝胆外科研究所 [2]大连医科大学附属大连市友谊医院肝胆外科,辽宁大连116001

出　　处：《中华腔镜外科杂志（电子版）》2014年第3期45-48,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的：探讨完全腹腔镜下胆囊部分切除术在保胆中的应用价值。方法自2008年4月至2013年9月对63例胆囊畸形的患者行腹腔镜联合胆道镜胆囊部分切除术。将胆囊畸形分为胆囊萎缩和折叠畸形两种，病变部位皆位于胆囊的远端，慢性炎症明显。其中胆囊萎缩21例，呈葫芦状；占胆囊1/4者11例，1/3者10例。折叠畸形42例，畸形与体部成角≥90度，或虽畸形与体部成角≤90度，但折叠处及其远端慢性炎症明显；占胆囊1/4者7例，其中向左折叠畸形3例，向右折叠畸形4例；1/3者15例，均向右折叠畸形；1/2者15例，向左折叠畸形1例，向右折叠畸形14例；2/3者5例，向左折叠畸形1例，向右折叠畸形4例。保留的胆囊功能正常：胆囊管通畅，胆囊壁≤3 mm，无明显炎症，胆囊收缩试验≥30%。本组合并胆囊结石57例，占90.5%，30例是黑色胆色素及以胆色素为主的混合性结石，占52.6%。27例是胆固醇及以胆固醇为主的混合性结石，占47.4%。切除有病变的胆囊后，胆道镜检查取净结石，4-0可吸收线连续两层缝合胆囊。结果63例手术均获成功，手术时间90-180（134.7±24.1）min；排气时间分别是18-30（25.3±3.7） h；胆漏3例，每日5-30 ml，术后4、6、10 d 拔除引流管，术后7-11 d痊愈出院。所有患者均获随访，随访时间3-65个月，患者术前临床症状消失，无胆囊切除术后腹痛、脂肪泻等并发症的临床表现，无结石复发；术后6-12月胆囊代偿性扩张，最小达4 cm ×2.5 cm ×2.5 cm，术后胆囊收缩试验57%±12%，较术前42%±12%明显提高（t =17.12； P＜0.001）。结论完全腹腔镜结合胆道镜胆囊部分切除术保胆治疗胆囊疾病，对保护胆囊及胆囊功能具有重要的意义，是一种新的保胆术式。Objective To study the feasibility of applying with laparoscopic and choledochoscopic to treat gallbladder deformity in partial cholecystectomy. Methods From April 2008 to September 2013, 63 cases of gallbladder deformity were treated by applying partial cholecystectomy with combined laparoscopic and choledochoscopic. All the patients were divided into atrophy group （n=21） and fold group （n =42）. The deformity at the far-end of gallbladder . The atrophy is a gourd-shaped form ;folde deformity in the angulation of ≥90 degree or it ≤90 degree but had evidently chronic inflammation. The function of＆amp;nbsp;the remain gallbladder were normal： ductus cysticus being unobstructed; the thickness of the gallbladder wall≤3 mm; contractibility of gallbladder test ≥30%. The 57 cases had cholelithiasis in it （90.5%）,30 cases had dark bile pigment gallstone（52.6%）, 27 cases had cholesterol gallstone（47.4%）. The deformity had were cutted off, taken all calculus out with choledochoscopy, 4 -0 absorbable thread to suture the gallbladder with two consecutive layers. Results All 63 cases were performed successfully. operation time： 90-180 （134.7±24.1）min,exhaust time： 18-30 （25.3±3.7） h; 3 cases had bile leakage every day 5-30 ml, the drain had been extubated in 4-10 day; and the patients were discharged 7-11 days after the operation. All patients have been followed up： follow-up time： 3-65 months; patients preoperative clinical symptoms disappeared; It didn’t occurred the postoperative complication of recurrence of calculi in the cases, and the gallbladder 4 cm×2.5 cm×2.5 cm, it test of contractibility of gallbladder of postoperative group being improved than preoperative group（57%±12% vs 42%±12%,t =17.12; P〈0.001）. Conclusions Partial cholecystectomy with combined laparoscopic and choledochoscopic is a effective method in treating gallbladder deformity on the condition of well knowing the indication, and it has a great significance in protecting the gallbladder and it

关 键 词：腹腔镜 胆囊部分切除术 保胆 

分 类 号：R657.4[医药卫生—外科学]