腹腔镜下联合胆道镜保胆取石50例报告

A Report on Fifty Cases of Mini-invasive Removing Gall-stone by Laparoscope and Choledochoscope in Combination.

目的探讨腹腔镜下联合胆道镜微创保胆取石治疗胆囊结石的可行性,方法,及临床应用价值。方法选择50例胆囊结石患者,腹腔镜下在胆囊底切开0.5～2cm切口,将胆道镜置入胆囊探查,取石网篮套出结石,生理盐水反复冲洗胆囊后,4-0可吸收线全层缝合胆囊切口。结果本组所有手术均顺利完成,术后胆漏2例,余患者均恢复良好。平均手术时间50分钟,平均住院时间3天,随访6～15个月,无结石复发。结论对结石数量少,胆囊功能良好,有保胆意愿的患者,腹腔镜下微创保胆取石不仅创伤小恢复快,又保存了胆囊的生理功能,避免了胆囊切除的诸多并发症,而且有益患者术后心理康复,方法简单,临床可行性大。

Objective To investigate the feasibility,technique and clinical application value of using the combination of Laparoscope and choledochoscope in mini-invasive removing gall-stone.Methods Firstly,to choose fifty cholecystolithiasis patients;secondly,to cut a 0.5cm-2cm kerf at the fundus of gallbladder with the help of Laparoscope,then put the choledochoscope into the cholecyst;thirdly,to extirpate the gall-stone by reticular basket,then douche the cholecyst with physiological saline time after time;fourthly,to sew up the wound of cholecyst with 4-0 absorbable thread.Results This set of operations had all been accomplished.There＇s only two cases of Bile leakage after the operation.All the other patients were favorably recovered.The average time for each operation is 50 minutes.The average length of stay is 3 days for each patient.In the follow-up visit of 6 to 15 months,there＇s no case of recrudesce had been found.Conclusion For those patients who have few gall-stones and well-functioned cholecysts,the new method not only helps the patients to recover quickly,but also protect their gallbladders.This method successfully avoids the various complication of the traditional cholecystectomy.In addition,this easy method is also beneficial to the psychological rehabilitation of patients.In all,the clinical application of mini-invasive removing gall-stone is quite feasible.