完全腹腔镜保胆取石术和息肉切除术(附68例报告)

Total laparoscopic cholelithotomy and polypectomy of gallbladder: a report of 68 cases

目的探讨完全腹腔镜下保胆取石和取息肉的手术方法和应用价值。方法总结2006年3月～2008年8月68例完全腹腔镜下保胆取石和取息肉术的经验,胆石症患者63例,其中单纯胆囊结石51例,行胆囊切开结合胆道镜取石,3-0可吸收线双层缝合胆囊;胆囊颈部结石嵌顿5例,行颈部切开取石成型术,用3-0可吸收线间断全层、单层缝合胆囊颈部,若颈部不扩张为预防狭窄则纵切横缝,针距、边距1.5mm;胆囊结合并胆总管结石7例,胆囊切开取石后行胆总管切开取石术。胆囊息肉5例,3例胆固醇性息肉用胆道镜取尽息肉;2例为胆囊腺瘤样息肉,行胆囊部分切除术。结果68例保胆患者手术均获成功,有1例合并胆总管结石的患者因胆总管取石困难中转开腹。胆漏2例,术后每天10mL,共2d,术后4d拔除腹腔引流管。手术时间80～240(109±33)min(包括胆总管切开取石术)。术后住院4～10(6.0±0.8)d,所有患者均治愈。获随访患者58例,随访时间1～29个月,结石复发1例,占1.59%。结论完全腹腔镜下保胆取石和取息肉术对于保留胆囊及胆囊功能具有重要的意义,特别是胆囊部分切除术、胆囊颈部成型术对于治疗胆囊腺瘤样息肉、胆囊颈部结石嵌顿是一种新的保胆术式和方法。

[Objective] To discuss the methods and application value of treating the cholecystolithiasis and polyps with laparoscope and choledochoscope for preservation of cholecyst. [Methods] The clinical date of 68 patients with cholelithiasis and cholecystic polyp who were treated by laparoscope and choledochoscope between Mar. 2006 and Aug. 2008 were analyzed. In 51 cases with simple gallstone, the bottom of gallbladder was incised with electrosurgical knife of laparoscope, then all the stones were removed with choledochotome, the incision of gallbladder was sutured with 3-0 absorbable suture by two-layers suturing method. For 5 cases with stone incarcerated in the neck of gallbladder, gallbladder neck was cut, the stones were removed, and then the plastic operation was performed with 3-0 absorbable suture and single-layer suturing method. If the neck was not dilated, the incision was sutured with transversal incising and vertical suturing method. In 7 cases with gallstones complicated with choledocholithiasis, the choledocholithotomy was performed besides the cholecystolithotomy. Of the 5 cases with cholecystic polyps, 3 cases had cholesterol polyps of gallbladder, the polyps were removed with eholedochoscope. Two cases had adenomas of gall bladder, partial cholecystectomy was performed on them. [Results] The operation had been performed successfully on aLl the cases, 1 case of gallstone that was complicated with choledocbolithiasis changed to open choledocholithotomy. Two patients had bile leakage 10 mL a day for 2 days, the drainage tubes of abdomen were pulled out on 4th postoperative day. The operation time was 85 -240 （109±33） minutes, the postoperative hospital stay was 4-10 （6.0±0.8） days. All the patients were eured. After 1-29 months follow-up of 58 cases, 1 ease （1.59%） had stone recurrence. [ Conclusions] Total laparoscopic cholelithotomy and polypectomy of gallbladder have important roles for preservation gallbladder, especially, partial cholecystectomy and gallbladder neck plastic operation are the new operative methods safe and feasible in treating the adenomatoid polyp of gallbladder and the stones incarcerated in the neck of gallbladder.