硬质超声胆囊内镜系统在保胆取石手术中的应用价值

Clinical applied value of compact endoscopic ultrasonography of gallbladder in the gallbladder-retention cholelithotomy

目的为了准确了解胆囊结石、胆囊息肉患者胆囊、胆囊壁的病理变化,探讨硬质超声胆囊内镜系统临床应用的可行性。方法 2008年6月～11月,自主研发CHiAO(桥牌)硬质超声胆囊内镜系统(专利号:ZL200920005583.1),实施保胆取石(息肉)手术39例。术中依据硬质超声胆囊内镜系统的检查结果,用取石网、小结石吸取箱清除胆囊腔内结石、泥沙洋结石、胆泥;用推、挤、压、撕、撑、冲、吸7种手法清除胆囊黏膜下结石;对于息肉,根据硬质超声胆囊内镜系统检查所显示胆囊黏膜的完整性、胆囊壁各层次的变化、息肉的形态等信息,判定息肉的性质并决定治疗方案,良性者保留胆囊,切除息肉。取4mm×5mm胆囊组织、胆汁、结石、息肉送去做相关检查。结果 39例手术成功,平均手术时间65min,术后第1天均可下床活动,平均住院时间4d。单发结石6例,多发33例,数目1～80颗,直径2～34mm。合并胆囊息肉12例,直径1～1.5mm,数目1～20粒;黏膜下结石13例438窝,占33.33%,每例3～108窝。术中超声检查结石取净率100%。随访1～6个月,无特殊不适。硬质超声胆囊内镜系统图像质量明显优于体表超声检查,与病理诊断符号率100%。结论硬质超声胆囊内镜系统是一种新设备,为保胆取石技术及胆囊病的临床研究提供了新平台。对手术中准确了解胆囊结石(息肉)患者胆囊壁各层次的变化有重要意义。用硬质超声胆囊内镜系统进行保胆取石(息肉)是一种安全、有效、可行的新方法。

【Objective】To explore the pathological change of gallbladder and gallbladder wall of the Cholecystolithiasis and Gallbladder Polyps patients exactly,and to approach the clinical applied feasibility of compact endoscopic ultrasonography of gallbladder.【Methods】We used the compact endoscopic ultrasonography of gallbladder which branded CHiAO （Patent number： ZL 20092000583.6）,to implement 39 cases of gallbladder -retention cholelithotomy or polypectomy operations during June,2008 to November,2008.During the operation,we collected the stones or muddy stone in the gallbladder cavity with the stone extractor or cholecyst muddy stone suction box according to the examination of the compact endoscopic ultrasonography of gallbladder,we took these manipulations such as thrust,stamp,tear,hold,dash and inhale to get submucous stones.We assessed the nature of the polyps and decided the treatment according to the integrity of mucosa and the changes of gallbladder wall at all levels as well as the morph of the polyps,and retained gallbladder when it was benign,at meantime,got mucosa of gallbladder sized about 4×5mm,the bile,the stones and the mucosa of gallbladder were sent for examination.【Results】All the 39 cases＇ operations were successful,the mean operative time was 65 mins,all the patients could get out of bed on the first day after the operation,and the average length of stay in the hospital was 4 days.During the operation,we found that 6 of them were single stones,and 33 of them were multiple stones,which ranged from 1 to 80 pills in number and 2 to 34mm in diameter;12 of them were stones with polyps,which were 1 to 1.5mm in diameter and 1 to 20 pills in number;13 of them,occupied 33.33%,were with submucous stones,ranged from 3 to 108 clutch each case,and 438 clutch totally.During the operation,the ultrasonograph showed 100% of the stones were removed.We took 1 to 6 months＇ follow-up,the patients felt no special uncomfortable.The image quality of the compact endoscopic ultrasonography of gallbladder was much better than exosomatic ultrasonic examination,and the consistent rate between pathology and compact endoscopic ultrasonography of gallbladder was 100%.【Conclusions】Compact endoscopic ultrasonography of gallbladder is new equipment;it is of importance in providing new platform for the clinical research of gallbladder-retention cholelithotomy and cholecystosis as well as in making clear the changes of gallbladder wall at all levels of Cholecystolithiasis and Gallbladder Polyps patients exactly.It is a safe,effective and feasible new method to use compact endoscopic ultrasonography of gallbladder in the gallbladder -retention cholelithotomy or polypectomy operations.