内镜微创保胆手术中几种特殊情况的处理

Management of several special circumstances in the minimal invasive operation with gallbladder preserved with choledochoscopy

目的通过探讨内镜微创保胆手术中几种特殊情况的处理,完善保胆手术方法,提高成功率。方法胆囊壶腹部嵌顿结石使用碎石器破碎后取出,壁间结石使用活检钳撕开胆囊黏膜后取出,胆囊内细碎结石使用结石吸附器吸出,胆囊息肉使用电活检钳切除,息肉切除后创面出血使用球形电极凝固。结果胆囊壶腹部结石嵌顿患者55例经碎石后取出结石,壁间结石患者235例(607处)经钳夹全部取净,胆囊内细碎小结石97例经吸引全部取出,胆囊息肉切除后创面出血187例全部止血彻底,使内镜微创保胆手术得以顺利实施。结论内镜微创保胆手术的不断创新,解决了手术中存在的问题,使内镜微创保胆手术更加完善,保胆成功率更高,并发症更少。

[Objective ] To explore the management of several special circumstances in the minimal invasive oper- ation with gallbladder preserved with choledochoscopy, improve the operative means and increase the success rate. [Methods ] We introduced how to solve several special problems such as gallbladder ampulla incarcerated stones, in- tramural stones, gallbladder stones with a small fine and after removal of gallbladder polyps treatment of the wound to be stanched completely. We needed corresponding facilities to complete the treatments. Some equipments would be made by om^eff. [ Results ] 55 eases gallbladder ampulla incarcerated stones by shatter, 235 eases intramural stones （607 aggregately） by forceps clip and 97 cases of small fine stones by suction all were removed thoroughly from the gallbladder. There were 187 eases after polypectomy bleeding wound to be stanched completely. So that the minimal invasive operation with gallbladder preserved with eholedochoscopy could be finished successfully. [ Conclusion ] The minimal invasive operation with gallbladder preserved with eholedoehoscopy requires constant innovation, solving several special problems to make the operation have higher success rate and less complications.