胆囊部分切除术治疗胆囊形态异常合并泥沙样结石性胆囊炎的效果分析  

Value of gallbladder-preserving partial cholecystectomy in treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis

作　　者：梁法生[1] 兰云霞[1] 梁杰[1] 丁洁[1] 高晓军[1] 

机构地区：[1]大连医科大学附属大连市友谊医院肝胆外二科,大连市肝胆外科研究所,辽宁大连116001

出　　处：《临床肝胆病杂志》2016年第10期1932-1935,共4页Journal of Clinical Hepatology

摘　　要：目的探讨腹腔镜下胆囊部分切除术治疗胆囊形态异常合并泥沙样结石性胆囊炎的应用价值。方法选取2010年7月-2014年1月于大连市友谊医院行腹腔镜联合胆道镜胆囊部分切除术治疗的胆囊形态异常合并泥沙样结石性胆囊炎患者18例。所有患者均伴有胆囊形态的异常,表现为胆囊折叠或胆囊腺肌症;病变部位皆位于胆囊的远端。术前将胆囊病变部分和正常胆囊拟保留部分分别做胆囊收缩试验。术中胆道镜检查胆囊管通畅,胆囊壁弹性好,无明显慢性炎症。切除有病变的胆囊后,4-0可吸收线连续两层缝合胆囊。计量资料组间比较采用独立样本t检验。结果所有患者手术均获成功,手术时间平均（98.0±9.0）min,排气时间平均（22.8±2.5）h。术后6 h下床活动并进水,24 h后进食;术后5~7 d痊愈出院,无胆漏等并发症发生。随访6~80个月,患者术前临床症状消失,无结石复发。术后6~12个月胆囊代偿性扩张,体积平均（30.29±4.23）cm3,较术前（21.72±4.34）cm3明显增大（t=-13.00,P〈0.001）;术后胆囊收缩平均（56.9±10.9）%,较术前（48.5±12.7）%显著提高（t=-6.11,P〈0.001）。结论腹腔镜结合胆道镜行胆囊部分切除术治疗胆囊形态异常合并泥沙样结石性胆囊炎,对保护胆囊及胆囊功能具有重要意义,在严格掌握适应证的情况下有望成为手术保胆治疗的一种新术式。Objective To investigate the value of laparoscopic gallbladder-preserving partial cholecystectomy in the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis. Methods A total of 18 patients with abnormal gallbladder morphology complicated by sand-like calculous cholecystitis who underwent laparoscopic and choledochoscopic partial cholecystectomy in Dalian Friendship Hospital from July 2010 to January 2014 were enrolled. All the patients had abnormal gallbladder morphology manifested as folded gallbladder or adenomyosis,and the lesions were located in the distal end of the gallbladder. Before the surgery,gallbladder contraction test was performed for the diseased part and the normal part of the gallbladder to be preserved. During the surgery,choledochoscopy showed an unobstructed cystic duct and good elasticity in the gallbladder wall,and there was no marked chronic inflammation. After the diseased part of the gallbladder was removed,4-0 absorbable suture was used for two-layer consecutive suture of the gallbladder. The t-test was used for comparison of continuous data between groups. Results All the patients underwent the surgery successfully. The mean time of operation was 98. 0± 9. 0 minutes,and the mean time to first flatus was 22. 8 ± 2. 5 hours. The patients were able to get out of the bed and drink water at 6 hours after surgery and to have meals at 24 hours after surgery. They fully recovered and were discharged at 5-7 days after surgery,and no patient experienced the complications such as bile leakage. The patients were followed up for 6-80 months; the patients＇ preoperative clinical symptoms disappeared,and there was no recurrence of calculi. At 6-12 months after surgery,the patients experienced compensated cholecystectasis,and there was a significant increase in the mean volume of the gallbladder after surgery（ 30. 29 ± 4. 23 cm3 vs 21. 72 ± 4. 34 cm3,t =-13.00,P〈0. 001）. There was a significant increase in mean gallbladder contraction after surgery�

关 键 词：胆囊炎 胆囊切除术 腹腔镜 治疗 

分 类 号：R657.4[医药卫生—外科学]