腹腔镜胆囊部分切除术保胆治疗慢性非结石性胆囊炎(附21例报告)  

Laparoscopic partial cholecystectomy for treatment of chronic non-calculous cholecystitis with cholecyst preservation:a report of 21 cases

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

机构地区：[1]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：《中国现代医学杂志》2016年第22期112-115,共4页China Journal of Modern Medicine

摘　　要：目的：探讨腹腔镜下胆囊部分切除术保胆治疗慢性非结石性胆囊炎的应用价值。方法选取2009年11月-2015年6月对大连医科大学附属大连市友谊医院21例慢性非结石性胆囊炎的患者行腹腔镜联合胆道镜胆囊部分切除术。21例均伴有胆囊形态的变化，病变部位皆位于胆囊的远端，慢性炎症明显，胆囊病变形态：向右折叠18例，占85.7%；胆囊底部腺肌症3例，占14.3%。病变占胆囊比例：≤1/3者11例，占52.4%；≤1/2者3例，占14.1%；≤2/3者7例，占33.3%。适应证：①胆囊病变位于远端，慢性炎症明显，且≤2/3；②拟保留胆囊部分胆囊功能正常，无明显炎症，胆囊壁≤3 mm；③胆囊收缩试验≥30%；术前将胆囊慢性炎症部分和正常胆囊拟保留部分分别做胆囊收缩试验；④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，胆道镜检查保留端胆囊无异常，4～0可吸收线连续两层缝合胆囊。结果21例手术均获成功，手术时间（110±18）min，排气时间分别是（21.4±2.8）h；术后6 h进水，30 h进食；术后7 d痊愈出院。患者随访（6~66）个月，术前临床症状消失，饮食正常。术后（6~12）个月胆囊代偿性扩张，体积达（56.67±23.2）cm3，较术前（48.26±21.58）cm3增大（P=-9.38，P〈0.05）；术后胆囊收缩试验（50.19±4.27）%较术前（45.67±6.87）%显著提高（=-5.22，P〈0.05）。结论腹腔镜结合胆道镜胆囊部分切除术保胆治疗慢性非结石性胆囊炎，对保护胆囊及胆囊功能具有重要意义，在掌握适应证的情况下有望成为手术治疗慢性胆囊炎的一种新术式。Objective To study the feasibility of applying laparoscopic partial cholecystectomy to treatment of chronic non-calculous cholecystitis. Methods From November 2009 to June 2015, 21 cases with chronic non-calculous cholecystitis, gallbladder deformity and adenomyomatosis were treated by partial cholecystectomy under laparoscope and choledochoscope. All the patients had deformity of gall bladder and evident chronic inflammation at the distal-end of gallbladder. The function of the remain gallbladder was normal：ductus cysticus being unobstructed, the thickness of the gallbladder wall ≤ 3 mm and contractibility of gallbladder test ≥ 30%. The proportion of the gallbladder lesion accounted for≤1/3 in 11 cases （52.4%）,≤1/2 in 3 cases （14.1%） and≤2/3 in 7 cases （33.3%）. The deformity part was cut off, the remained part was normal under choledochoscope. 4-0 absorbable thread was used to suture the gallbladder with two consecutive layers. Results The operations were performed successfully in all the patients. The operation time was （110 ± 18） min,the exhaust time was （21.4 ± 2.8） h; and the patients weredischarged 7 days after operation. The patients were followed up for 6-66 months. The preoperative clinical symptoms of the patients disappeared. There was no postoperative complication in the cases. The gallbladder had compensatory dilatation with the volume to （56.67 ± 23.2） cm3 which was significantly larger than the preoperative volume [（48.26 ± 21.58） cm3,P= -9.38, P〈 0.05]. The postoperative contractibility of gallbladder was enhanced after operation [（50.19 ± 4.27）%vs （45.67 ± 6.87）%, =-5.22, P〈0.05]. Conclusions Partial cholecystectomy with combined laparoscopy and choledochoscopy is an effective method in treating chronic non-calculous cholecystitis with the indications, and it has a great significance in protecting gallbladder and its function.

关 键 词：腹腔镜 胆囊部分切除术 保胆 胆囊形态 慢性非结石性胆囊炎 

分 类 号：R657.42[医药卫生—外科学]