胆道镜下定向微爆破技术治疗胆囊巨大、嵌顿结石在保胆取石术中的临床应用

Application of choledochoscope guided lithoclasty for huge and incarcerated cholecystolithiasis in laparoscopic gallbladder-preserving cholelithotomy

目的:探讨胆道镜下定向微爆破碎石技术治疗胆囊巨大、嵌顿结石在保胆取石术中的安全性及可行性。方法:采用体内微爆破碎石仪在纤维胆道镜直视下定向碎石治疗93例胆囊巨大、嵌顿结石患者。结果:93例患者碎石2～11次,平均(3.67±0.52)次1,例术后发生急性胆囊炎,急诊行经皮经肝胆囊穿刺引流;1例胆囊壁水肿置管引流,6周后经胆道镜探查胆囊粘膜恢复正常后拔除。91例用4-0可吸收线一次性缝合胆囊壁,所有患者术后均无胆囊穿孔、胆漏、胆囊出血等并发症发生,无一例中转胆囊切除术。结论:在胆道镜直视下应用体内微爆破定向碎石技术治疗胆囊巨大、嵌顿结石安全、有效,为保胆手术的成功提供了理想的手术方法。

Objective：To investigate the safety and feasibility of choledochoscope guided lithoclasty for huge and incarcerated cholecystolithiasis in gallbladder-preserving cholelithotomy. Methods：Ninety-three patients with huge and incarcerated cholecystolithiasis underwent the treatment and clinical data was analyzed retrospectively. Results：All the operations were successfully performed without conversion to cholecystectomy.All patients underwent 2-11 times of lithoclasty,with the average of（3.67±0.52）.The gallbladder wall of 91 cases was sutured with 4-0 absorbable thread.Acute cholecystitis occurred in 1 case after operation,which was performed emergent percutaneous transhepatic gallbladder puncture and drainage.1 case underwent drainage because of gallbladder wall edema,and the drainage tube was removed 6 weeks later,when the gallbladder mucosa was normal under choledochoscopy.No other postoperative complications occurred such as gallbladder perforation,bile leakage or hemorrhage. Conclusions：Lithoclasty under direct view of choledochoscope is safe and effective for huge and incarcerated cholecystolithiasis,and it is an ideal treatment for gallbladder-preserving cholelithotomy.