浙江临床医学
浙江臨床醫學
절강림상의학
ZHEJIANG CLINICAL MEDICAL JOURNAL
2014年
7期
1052-1054
,共3页
孙伟军%孙玲国%宋美娟%周亚萍%胡德扬
孫偉軍%孫玲國%宋美娟%週亞萍%鬍德颺
손위군%손령국%송미연%주아평%호덕양
胆囊结石%胆囊息肉%胆囊结石嵌顿%保胆手术%胆囊功能检测
膽囊結石%膽囊息肉%膽囊結石嵌頓%保膽手術%膽囊功能檢測
담낭결석%담낭식육%담낭결석감돈%보담수술%담낭공능검측
Gallbladder stone%Gallbladder polyp%Incarcerated gallbladder stone%Cholecystolithotomy%Gallbladder function test
目的：探讨二镜联合内镜微创保胆取石（息肉）的可行性。方法在全麻下经脐孔穿刺建立气腹，腹腔镜下观察胆囊形态，分离粘连，若胆囊因结石嵌顿而胀大、积脓，先穿刺减压，切开胆囊底部，纤维胆道镜下取出结石，清理胆囊腔，确定胆囊管通畅后，缝合切口，保留胆囊，再次气腹探查腹腔，吸引肝周边积液，缝合腹壁切口。结果本组162例，保胆成功142例（83.33%）其中胆囊壶腹部结石嵌顿伴炎症保胆成功22例。手术时间25-130min，平均50min，无严重并发症。住院时间6~16d。术后1~9年随访，信（电话）获访132例（92.9%），均无发热、腹痛、黄疸及再手术情况。术后1~3个月专家门诊复查87例（57%）145人次，胆囊正常60例（74%），小结石残留7例（8.9%），腔内小结晶或沉淀物14例（17.2%）。85例B超脂肪餐前后检测胆囊结石11例，结石复发率12.94%。胆囊收缩率最大为98%，最小为42%，平均（67.7±18.9）%，显示胆囊收缩功能评级良好72例（84.7%）、功能差13例（15.3%）。胆囊壶腹部结石嵌顿保胆术后胆囊功能与非结石嵌顿保胆术后胆囊功能相类似（P<0.05）。结论二镜联合内镜微创保胆取石（息肉）安全、可行。
目的：探討二鏡聯閤內鏡微創保膽取石（息肉）的可行性。方法在全痳下經臍孔穿刺建立氣腹，腹腔鏡下觀察膽囊形態，分離粘連，若膽囊因結石嵌頓而脹大、積膿，先穿刺減壓，切開膽囊底部，纖維膽道鏡下取齣結石，清理膽囊腔，確定膽囊管通暢後，縫閤切口，保留膽囊，再次氣腹探查腹腔，吸引肝週邊積液，縫閤腹壁切口。結果本組162例，保膽成功142例（83.33%）其中膽囊壺腹部結石嵌頓伴炎癥保膽成功22例。手術時間25-130min，平均50min，無嚴重併髮癥。住院時間6~16d。術後1~9年隨訪，信（電話）穫訪132例（92.9%），均無髮熱、腹痛、黃疸及再手術情況。術後1~3箇月專傢門診複查87例（57%）145人次，膽囊正常60例（74%），小結石殘留7例（8.9%），腔內小結晶或沉澱物14例（17.2%）。85例B超脂肪餐前後檢測膽囊結石11例，結石複髮率12.94%。膽囊收縮率最大為98%，最小為42%，平均（67.7±18.9）%，顯示膽囊收縮功能評級良好72例（84.7%）、功能差13例（15.3%）。膽囊壺腹部結石嵌頓保膽術後膽囊功能與非結石嵌頓保膽術後膽囊功能相類似（P<0.05）。結論二鏡聯閤內鏡微創保膽取石（息肉）安全、可行。
목적：탐토이경연합내경미창보담취석（식육）적가행성。방법재전마하경제공천자건립기복，복강경하관찰담낭형태，분리점련，약담낭인결석감돈이창대、적농，선천자감압，절개담낭저부，섬유담도경하취출결석，청리담낭강，학정담낭관통창후，봉합절구，보류담낭，재차기복탐사복강，흡인간주변적액，봉합복벽절구。결과본조162례，보담성공142례（83.33%）기중담낭호복부결석감돈반염증보담성공22례。수술시간25-130min，평균50min，무엄중병발증。주원시간6~16d。술후1~9년수방，신（전화）획방132례（92.9%），균무발열、복통、황달급재수술정황。술후1~3개월전가문진복사87례（57%）145인차，담낭정상60례（74%），소결석잔류7례（8.9%），강내소결정혹침정물14례（17.2%）。85례B초지방찬전후검측담낭결석11례，결석복발솔12.94%。담낭수축솔최대위98%，최소위42%，평균（67.7±18.9）%，현시담낭수축공능평급량호72례（84.7%）、공능차13례（15.3%）。담낭호복부결석감돈보담술후담낭공능여비결석감돈보담술후담낭공능상유사（P<0.05）。결론이경연합내경미창보담취석（식육）안전、가행。
Objective To study the feasibility of minimally invasive cholecystolithotomy for stone or polyp under combined use of laparoscope and choledochoscope. Methods Pneumoperitoneum was establishd via umbilical incision and puncture under general anesthesia ,gallbladder was observed under laparoscoe and the adhesion was separated,if the gallbladder appeared swelling with empyema because of the incarcerated calculus, decompression was applied with puncture perform.Then the bottom of the gallbladder was open,the stones were taken out under fiber choledochoscope,the gallbladder cavity was cleaned up,the cystic duct was confirmed of no obstruction,the incisions were sutured upwith gallbladder retained . The pneumoperitoneum was establish again,the surrounding liver effusion was removed with suction,the abdominal incision was sutured up. Results Of the 162 cases,gallbladders were retained successfully in 14 2 cases(83.33%),including 22 cases of inflammatory gallbladde with stones incarcerated at the pot belly.Operation time was 25-130 minutes withaverage of 50 minutes,no serious complications occurred . The hospital stay were 6-16. 132 cases(92.9%)were followed-up postoperative for 1-9 years via the mail (phone),no fever,no abdominal pain,no jaundice and reoperation occurred. 87 cases(57%)of 145 patients had clinic follow up 1~3 month postoperatively . 60 cases(74%)had normal gallbladder,7 cases(8.9%)had small residual stone . 14 cases(17.2%)with small crystals or sediment. 85 cases received ultrasound scan before and after the fat food, 13 cases had recurrent gallbladder stone with recurrence rate of 12.94%.The maximum gallbladder contraction ratio was 98%,the minimum was 42%,the average was 67.7%±18.9%.The gallbladder contraction function rating appeared good of 72 cases(84.7%)and poor of 13 cases(15.3%).There was no difference between the gallbladders with calculus incarcerated and those without.(P<0.05). Conclusion Minimally invasive cholecystolithotomy for stone or polyp under combined use of laparoscope and choledochoscope is safe and feasible.
