全腹腔镜下保胆取石即时缝合术367例报道

Report on laparoscopic removal of cholecyst lithiasis with primary closure of cholecyst incision for preservation of cholecyst in 367 cases

目的探讨全腹腔镜下保胆取石即时缝合术的手术方法和适应证。方法 367例患者在全身麻醉下采用腹腔镜胆囊切除术的标准四戳孔,借助胆道镜、取石网、输尿管导管和斑马导丝处理胆囊结石和胆囊管开口。胆囊壁切口用3-0号可吸收缝线间断"8"字缝合或连续扣锁缝合,再用一小束修整过的带血管蒂的大网膜缝扎固定于胆囊壁切口处,胆囊周围放置防粘止血贴。取出的胆囊结石装入标本袋并从剑突下孔或脐部孔取出,Winslow孔附近常规放置一根16 F脑室引流管观察渗漏情况。结果施行保胆取石即时缝合术367例,成功338例,中转为腹腔镜胆囊切除术24例,胆漏3例,残余结石1例,胆道出血1例。腹腔引流管引流出渗出液10～300 ml/d,术后2～7 d拔除引流管。无中转开腹及死亡病例。手术时间30～160 min,平均71 min。术后住院时间3～11 d。结论只要严格选择合适的病例,确切的胆道镜检查和治疗,可靠精确的缝合和覆盖胆囊壁切口,施行全腹腔镜下保胆取石即时缝合术是可行、有效、安全的。此方法可以长期保留有功能的胆囊,以满足部分患者心身健康的需要。

Objective The purpose of this paper was to discuss the methods and indications of treating the cholecyst lithiasis by laparoscopy and choledochoscopy for preservation of cholecyst.Methods A pospective study of 367 patients of treating the cholecyst lithiasis by laparoscopy and choledochoscopy for preservation of cholecyst had been operated between March 2002 and November 2010.It was first adopted that extraction of the gall bladder stones with choledochoscopy,that the incision of the gall bladder were performed with absorbable suture 3-0（polyglycolic acid bralded suture） by suturing method of primary closure of cholecyst incision.Results It had completed successful cholecyst clerrance to reach the preestablished object of preservation of cholecyst to 338 patients in total 367 patients.It changed laparoscopic preservation of cholecyst into laparoscopic cholecystectomy in 24 patients.It had leaked the bile juice continue to heal up in 3 patients,One patient had residual stones then cured with laparoscopic cholecystectomy.One patient had the bleeding of bile duct to heal up with non-operation.Conclusions If patients are suitable,this method is safety and feasible that had completed successful cholecyst lithiasis clearance and the incision of the gall bladder were performed with absorbable suture by the primary closure method,it was for preservation of the functional cholecyst.