腹腔镜联合胆道镜保胆取石术109例报告  

Laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy: with a report of 109 cases

作　　者：马晗[1] 李平[1] 江涛[1] 李栋[1] 李永崇 赵彦礼[1] 蔡天勇[1] 

机构地区：[1]石河子大学医学院第四附属医院,新疆阿克苏843000

出　　处：《腹腔镜外科杂志》2014年第9期696-698,共3页Journal of Laparoscopic Surgery

摘　　要：目的：评价腹腔镜联合胆道镜保胆取石术的临床疗效。方法：回顾分析2009年11月至2013年11月为109例胆囊结石患者行腹腔镜保胆手术的临床资料。结果：109例均顺利完成手术。手术时间45-110 min,平均（77.3±19.8）min;术中出血量5-15 ml,平均（8.2±3.6）ml;术后下床活动时间8-36 h,平均（18.5±9.9）h;术后肛门排气时间14-56 h,平均（28.2±10.3）h;术后住院2-5 d,平均（3.4±0.8）d。术后无出血、胆漏、急性胆囊炎、胆囊残留结石、胆管结石、胆管炎等并发症发生。术后随访1-39个月,均无胆囊恶变;1例于术后14个月结石复发合并急性胆囊炎,胆囊三角粘连致密,行腹腔镜手术时中转开腹行胆囊切除术;1例于术后26个月复发,行腹腔镜胆囊切除术;余者均无结石复发及右上腹疼痛、肩背部疼痛等症状。结论：腹腔镜联合胆道镜保胆取石术具有患者创伤小、术后康复快等优点,保留了胆囊功能,值得临床推广应用。但有胆结石家族史、高脂血症及代谢综合征的患者应慎重选择保胆取石术。Objective： To evaluate the clinical efficacy of laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy. Methods： Retrospective analysis was made on clinical data of 109 patients who suffered from gallstone and underwent laparoscopic gallbladder-preserving operation from Nov. 2009 to Nov. 2013. Results： All the 109 operations were successful. Operation time was 45-110 min with an average of（ 77. 3 ± 19. 8） min; the amount of blood loss was 5-15 ml,average（ 8. 2 ± 3. 6） ml; the ambulation time after operation was（ 18. 5 ± 9. 9） h（ range,8-36 h）; postoperative anal exhaust time was（ 28. 2 ± 10. 3） h（ range,14-56 h）; postoperative hospital stay was（ 3. 4 ± 0. 8） d（ range,2-5 d）. No complications were found such as bleeding,bile leakage,acute cholecystitis,gallbladder residual stones,stones of bile duct or cholangitis. Patients were followed up for 1-39 months,no gallbladder canceration was found. 1 case of calculi recurrence combined with acute cholecystitis was found after 14 months,the patient was converted from laparoscopic operation to open cholecystectomy because of dense adhesion at gallbladder triangle. 1 case of recurrence occurred in 26 months after surgery,laparoscopic cholecystectomy was performed. Other patients did not suffer from stone recurrence,right upper quadrant pain,shoulder or back pain. Conclusions： Laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy is mini-invasive,worthy of clinical popularization with quick recovery,reserves the function of gallbladder. But gallbladder-preserving cholelithotomy should be considerately selected for patients with a family history of gallstone,hyperlipidemia and metabolism syndrome.

关 键 词：胆囊结石病 腹腔镜检查 胆道镜检查 保胆取石术 

分 类 号：R657.4[医药卫生—外科学]