胆囊颈部/颈管嵌顿结石微创治疗的探索

Minimally-invasive therapy for calculus incarcerated in the neck and duct of gallbladder

目的探索胆囊颈部/颈管嵌顿结石保胆治疗的技术方法及术后胆囊收缩功能的恢复。方法利用胆道镜下电切技术切开胆囊颈管结石前方的黏膜螺旋瓣及辅助应用等离子碎石技术碎石网篮取出,超细纤维胆道镜检查查胆囊颈管有无残石,留置胆囊引流管,术后6～8周胆道镜经瘘道检查胆囊,取出残石或吸净胆囊内絮状物或胆泥,引流管内的胆汁清亮,无絮状物拔除引流管。于8、12周脂餐试验测定胆囊的收缩功能。结果 20例患者手术全部成功,无1例发生胆漏、出血及胆道损伤,胆道镜检查见胆囊黏膜正常,无水肿、糜烂,有絮状物4例,经胆道镜下吸附器取净,8周后脂餐试验显示胆囊收缩功能:20%～49%的9例,大于50%的6例,12周后脂餐试验显示胆囊收缩功能其收缩率在60%以上。结论胆道镜下电切、等离子碎石及超细纤维胆道镜技术是处理胆囊颈部/颈管嵌顿结石的有效方法,颈部嵌顿结石的胆囊收缩功能可以恢复,扩大了保胆取石的手术范围。

[Objective] To investigate the operation for the minimally-invasive therapy for calculus incarcerated in the neck and duct of gallbladder and the gallbladder＇s systolic function restoration.[Methods] Through the choledochoscope,we remove the calculus using the electric scalpel to cut mucosa in the calculus incarcerated in the neck and duct,or combined with the technical of plasma to break the calculus.And then use the microfiber choledochoscope to examine the residual calculus,set T tube to drain bile,to check the gallbladder via the fistula 6-8 weeks postoperative,clearing the residual calculus,floc or biliary sludge,pull out the T tube when the bile becoming brighter and no flloc.Determine the gallbladder＇s systolic function 8 and 12 weeks postoperative.[Results] All the 20 patients have successful operation,no patients have bile leaks,bleeding and bile duct injury.We use the electronic choledochoscope to examine the glabladder along the fistula,and we find that the mucosa has no edema and erosion,4 cases have floc but clear thoroughly.The gallbladder＇s systolic function：8 weeks,9 cases,20%-49%,6 cases more than 50%.12 weeks,more than 60%.[Conclusions] The minimally-invasive surgery by the choledochoscope to get out calculus with the help of cut mucosa,plasma to break the calculus and microfiber choledochoscope is an effective method to treat calculus incarcerated in the neck and duct of gallbladder,the gallbladder＇s systolic function can recover.Expand the operation range.