623例内镜取石保胆术

Endoscopic cholecystolithotomy with reservation of gallbladder： a report of 623 cases

目的 探讨经内镜胆囊取石术治疗胆囊结石的指征及临床价值。方法 回顾性分析我院2000—2006年收治的712例胆囊结石患者临床资料。右上腹墨菲氏点处行2～4cm纵形切口，于胆囊底部无血管区戳孔，在胆道镜引导下取出结石。确认无结石残留，胆汁涌入胆囊后，以甲硝唑冲洗胆囊，可吸收线全层缝合戳孔并荷包包埋。结果符合适应证经内镜胆囊取石术623例，均痊愈出院。经1～5年随访475例，5例患者结石复发。结论保胆内镜取石术治疗胆囊结石疗效理想，但必须严格掌握适应证，术中必须观察到胆汁自胆囊管口涌入胆囊，否则需中转手术行胆囊切除术。

Objective To investigate the indication and clinical value of endoscopic cholecystolithotomy with reservation of gallbladder. Methods The clinical data of 712 patients with gallstone admitted in our hospital from March 2000 to December 2006 were retrospectively analyzed. The Murphy＇s point on the right upper quadrant was chosen for a longitudinal incision of 2-4 cm in length, and then an incision at fundus of gallbladder was made to remove the stones with choledochoscope. Gallbladder was washed with metronidazole after all stones were removed and the bile flowed into gallbladder, then the incision was sutured with absorbable thread. Results A total of 623 patients received endoscopic cholecystolithotomy with reservation of gallbladder and obtained satis- factory outcome. Of 475 patients who had been followed up for 1-5 years, 470 were cured with no infections or complications and 5 had cholecystolithiasis recurrence. Conclusions Endoscopic cholecystolithotomy with reser- vation of gallbladder is effective in treating cholecystolithiasis. The flow of Bile into gallbladder as an indication must be observed during operation, or conversion to cholecystectomy is necessary.