腹腔镜、硬质胆囊镜、软质胆道镜三镜技术在保胆取石（息肉）术的临床应用

Combination laparoscopy, hard gallbladder endoscopy and soft choledochoscopy for removing calculi （polyp） and conserving gallbladder

目的探讨应用腹腔镜、硬质胆囊镜、软质胆道镜三镜技术在微创保胆取石（息肉）术治疗胆囊结石（息肉）的临床应用价值。方法对2009年4月至2010年7月苏州大学附属第二医院肝胆外科采用三镜联合保胆取石（息肉）术的胆囊结石（息肉）122例患者的临床资料进行回顾性分析。结果122例患者中56例胆囊结石和24例胆囊息肉应用腹腔镜、硬质胆囊镜成功取净结石和息肉；34例胆囊结石联合应用三镜取净结石；8例患者中转腹腔镜胆囊切除术（LC）。取出结石的病例中，单发结石25例，多发结石65例，结石数1—52颗，直径0．2—3．2em。24例胆囊息肉样病变中，单发7例，直径1．0～1．2em；多发17例，直径0．4—1．0cm。手术时间40—125min，平均78min。术后平均住院时间4d。均无手术中或术后并发症发生。随访1年，胆囊内结石复发3例，复发率3．1％。结论腹腔镜、硬质胆囊镜、软质胆道镜三镜技术在保胆取石（息肉）术的应用是安全可行的，能提高结石取净率，增加保胆成功率。

Objective To-evaluate gallbladder-conserving gallstone removal and polyps resection using combination laparoscopy, hard gallbladder endoscopy and soft choledochoscopy. Methods Clinical data of 122 patients with cholecystolithiasis or polyps undergoing removal of calculus （polyps） and preservation of gallbladder were analyzed retrospectively. Results Gallstones in 56 patients and polyps in 24 cases was removed or resected successfully by laparoscopy and hard gallbladder endoscopy; In the remaining 34 cases stones were completely removed by combination soft choledochoscopy; 8 cases were converted to laparoseopic cholecystectomy. Romoved stone was single in 25 cases and multiple in 65 cases, with the number ranging from 1 to 52, the diameter of stone ranged from 0. 2 cm to 3.2 cm. In the 24 gallbladder polyps,7 cases were single, 17 cases were multiple, the diameter of polyp ranged from 0. 8 cm to I. 2 cm. The operation time was 40-125 （78） rain. The mean hospitalization was 4 days. No intraoperative and postoperative complications occurred. All patients were followed up for 1 year. Gallstones recurred in 3 cases, and the recurrence rate was 3.06%. Conclusions Laparoscopy combined with hard gallbladder endoscopy and soft choledochoscopy for removing calculi （polyp） and conserving gallbladder is safe and feasible.