小切口化学性胆囊切除临床应用

Application of Minor Incision Chemical Cholecystectomy

目的:总结临床上行小切口化学性胆囊切除的经验。方法:通过对23例胆囊结石患者采用右上腹3～5cm斜切口,在切口加用冷光源探头作照明,充分显露胆囊三角,直视下寻找胆囊管,用钛夹钳施钛夹来闭塞胆囊管,取尽胆囊结石及胆汁并向胆囊腔灌注硬化剂无水乙醇(≥99.5%),反复3次,硬化剂共灌注20min,胆囊底开放,放置胆囊窝引流管。结果:在灌注硬化剂时可见胆囊黏膜脱落、坏死,2周内胆囊明显萎缩,纤维组织开始形成,10周左右胆囊全部被纤维组织所代替,全部萎缩完全,23例胆囊全部化学性切除成功,除2例术后出现腹痛外,余未发现有并发症发生。结论:硬化剂灌注最佳时间为20min,硬化剂灌注要反复多次,小切口化学性胆囊切除是一种安全、可行的微创手术。

Objective:To summarize minor incision chemical cholecystectomy.Method:23 cases with gallstone were performed 3~5 cm incisions at the right costal margin. Then the calot's triangle was exposed sufficiently with the aid of cold light source.Under direct view the cystic duct was found out and damped with silver clip. After cleaning out gallstone and aspirating out the bile, anhydrous alcohol (99.5%)was perfused into gallbladder. The above procedure was repeated three times with total time of 20 minutes.Finally, the effluent tube was placed near the gall ladder bottom with gallbladder bottom open.Result:The gallbladder mucosa was necrotic and dropped out when the sclerosing agent perfused. Within two weeks, an obvious atrophy of the gallbladder occurred, fibrosis tissur formed. Within ten weeks, the whole gallbladder was instead of fibrosis tissue and completely atrophic. All cases by the chemical cholecystectomy were healed without the occurrence of complications, except for 2 cases appearing the abdomen pain after the chemical cholecystectomy.Conclusion:The optimal time of sclerosing agent perfusion was 20 minutes and the sclerosing agent should be perfused several times for the best therapeutic efficacy. Minor incision chemical cholecystectomy should be a kind of safe, feasible, minimally-invasive operation.