CAJ | 학술논문

目的探讨腹腔镜下飞行人员保胆取石和取息肉的手术适应证、方法和疗效以及对飞行人员术后复飞影响. 方法 2011年4月-2012年4月的7例飞行人员行腹腔镜下保胆取石和取息肉术.单纯胆囊结石患者4例,其中3例为单发结石,1例为多发胆囊结石；单纯胆囊息肉患者1例,为胆固醇性息肉；胆囊结石合并息肉患者2例,均为胆固醇性息肉.7例患者均行胆囊底部切开取石及取息肉术.胆囊切口采用4-0 prolene缝线连续缝合3例,采用3-0可吸收线间断缝合或连续缝合4例.术中使用胆道镜或腹腔镜查看胆囊内结石或息肉是否取净.所有患者术后地面观察1～3个月. 结果 7例保胆患者手术均获成功,没有1例中转剖腹手术.手术时间80～150 min.术后均恢复顺利.术后住院3～7 d,均治愈出院.所有患者均获随访,随访时间3～18个月,未发现胆囊结石或息肉复发.其中5例患者按时复飞,状况良好.另2例因患其他疾病(分别为血管性头痛及颈椎病)仍在地面观察中. 结论腹腔镜下保胆取石和取息肉术保留了胆囊及胆囊功能,维护了消化系统的正常功能.针对飞行人员胆囊结石(息肉)患者,有选择性地施行腹腔镜保胆取石(息肉)术有利于飞行人员术后复飞.
목적 탐토복강경하비행인원보담취석화취식육적수술괄응증、방법화료효이급대비행인원술후복비영향. 방법 2011년4월-2012년4월적7례비행인원행복강경하보담취석화취식육술.단순담낭결석환자4례,기중3례위단발결석,1례위다발담낭결석；단순담낭식육환자1례,위담고순성식육；담낭결석합병식육환자2례,균위담고순성식육.7례환자균행담낭저부절개취석급취식육술.담낭절구채용4-0 prolene봉선련속봉합3례,채용3-0가흡수선간단봉합혹련속봉합4례.술중사용담도경혹복강경사간담낭내결석혹식육시부취정.소유환자술후지면관찰1～3개월. 결과 7례보담환자수술균획성공,몰유1례중전부복수술.수술시간80～150 min.술후균회복순리.술후주원3～7 d,균치유출원.소유환자균획수방,수방시간3～18개월,미발현담낭결석혹식육복발.기중5례환자안시복비,상황량호.령2례인환기타질병(분별위혈관성두통급경추병)잉재지면관찰중. 결론 복강경하보담취석화취식육술보류료담낭급담낭공능,유호료소화계통적정상공능.침대비행인원담낭결석(식육)환자,유선택성지시행복강경보담취석(식육)술유리우비행인원술후복비.
Objective To discuss the operative indication,methods and therapeutic effect of treating the cholecystolithiasis and polyps by laparoscopic cholelithotomy and polypectomy for pilots,and to study the effects of treatment on pilot's career.Methods The clinical data of 7 pilots with cholelithiasis and cholecystic polyps,who were treated by laparoscopic cholelithotomy and polypectomy in the period from Apr.2011 to Apr.2012,were analyzed.Four cases out of 7 pilots were the only cholecystolithiasis,including 3 cases of single stone and 1 case of multiple stones.One simple cholecystic polyps case was the cholecystic cholesterol polyps.Two cases were the combination of cholecystolithiasis and cholecystic cholesterol polyps.In all cases,the bottoms of the gallbladders were incised by electrosurgical hook to remove all stones and polyps.The incisions were continuously sutured with 4-0 prolene in 3 cases,and other 4 cases were interruptedly or continuously sutured with 3-0 absorbable lines.Choledochoscope or laparoscope was used to supervise the clearance of stone and polyps.All pilots were temporally grounded and observed for 1-3 months.Results All cases were successfully treated and no further celiotomy was needed to them.The operation time was 80-150 min and pilots' hospitalized stay was 3-7 d.All pilots recovered smoothly.In 3 to 18 months follow up for all pilots,no stone or polyp recurrence was found.Five pilots were qualified for flying while the other 2 were still in observation respectively due to vascular headache and cervical spondylosis.Conclusions Laparoscopic cholelithotomy and polypectomy can preserve gallbladder function,be in favor of maintaining normal digestive function and be beneficial to pilot's recovery for flying.