飞行人员腹腔镜保胆取石术和息肉切除术初步经验与探讨

Preliminary experience and exploration of laparoscopic cholelithotomy and polypectomy of gallbladder for pilots

目的探讨腹腔镜下飞行人员保胆取石和取息肉的手术适应证、方法和疗效以及对空勤人员的术后放飞及飞行状况的影响。方法 2011年4月-2012年4月我们完成了6例飞行人员腹腔镜下保胆取石和取息肉术。单纯胆囊结石患者3例,其中2例为单发结石,1例为多发胆囊结石;胆囊息肉患者1例,胆囊结石合并息肉患者2例,均为胆固醇性息肉。6例患者均行胆囊底部切开取石及取息肉术。胆囊切口采用4-0 prolene缝线连续缝合2例,采用3-0可吸收线间断或连续缝合4例。术中使用胆道镜1例,另5例未用胆道镜,用腹腔镜代替胆道镜查看胆囊内结石或息肉是否取净。术后放置腹腔引流管2例。胆囊结石(包括合并胆囊息肉)患者术后服用利胆药物1个月,1例胆囊息肉患者术后未服利胆药物。所有患者术后地面观察3个月。结果 6例保胆患者手术均获成功,没有1例中转剖腹手术。手术时间85～145(95±22)min。术后均恢复顺利。术后住院3～7(5.0±2.0)d,均治愈出院。所有患者均获随访,随访时间1～14个月,未发现胆囊结石或息肉复发。其中3例患者按时复飞,状况良好。另3例患者地观期尚未结束,目前状况良好,无不适主诉。结论腹腔镜下保胆取石和取息肉术保留了胆囊及胆囊功能,有利于维护飞行人员消化系统的正常功能。只要胆囊大小基本正常、胆囊壁增厚不明显、胆囊功能基本正常,并且患者及家属保胆愿望强烈,均可进行腹腔镜保胆取石(息肉)术。术式以采用胆囊底部切口、可吸收线缝合为好,只要缝合可靠,不必放置腹腔引流管。术后近期服用利胆药物可能对预防结石复发有益。腹腔镜保胆取石及取息肉术对飞行人员复飞无明显不良影响。

Objective We aim to discuss the operation indications, methods and therapeutic effects of treating the cholecystolithiasis and polyps by laparoscopic cholelithotomy and polypectomy for pilots, and to study their postoperative flying and flying condition. Method The clinical data of 6 pilots with cholelithiasis and cholecystic polyps, who were treated by laparoscopic cholelithotomy and polypectomy between April 2010 and April 2012, were analyzed. Of the 6 patients, 3 cases suffered from only cholecystolithiasis including 2 patient with single stone and 1 patients with multiple stones, 1 case suffering from cholecystic polyps（cholesterol polyp）, and 2 cases simultaneously suffering from cholecystolithiasis and cholecystic polyps. In all the cases the bottom of gallbladder were incised by electrosurgical hook, and all the stones and polyps were removed. The incisions were sutured continuously with 4/0 prolene line in 2 cases,and interrupted or continuous suture were performed with 3/0 absorption line in the other 4 cases. Choledochoscope along with laparoscope was used in 1 case and only laparoscope was used to see if the stones and polyps had been taken away completely in the other 5 patients during operation. Celiac drainage tubes were placed respectively in 2 cases. Five patients with cholecystolithiasis took choleretic drugs for one month after operation, and the one case with only polyps took no choleretic drug. All the cases who are pilots underwent ground observation for 3 months. Result The operation had been performed successfully on all the six cases, and none of them was changed to celiotomy. The operation time was 85-145 （95~22） minutes. All the cases recovered smoothly. All the patients were cured and their mean postoperative hospital stay was 3-7 （5.0-t-2.0） days, and subsequently fully follow up was performed from 1 month to 14 months after operation. No stone or polyp recurrence was found in all the cases. Three pilots return to flying on schedule; the others were still in the period of land observation. Conclusions Laparoscopic cholelithotomy and polypectomy can preserve gallbladder function and help maintain normal digestive function of the pilot patients. If the size, wall thickness, and function of the gallbladder are nearly normal, and both suffers and their family members have the strong desire to preserve cholecyst, laparoscopic cholelithotomy and polypectomy can be performed. It may be preferable to excide fundus of gallbladder and suture the incision by absorption line. A peritoneal drainage tube nearby Winslow hole is not necessary if the incision was sutured reliably. Taking choleretic preparations for one or more months after operation is beneficial for preventing gallbladder stone recurrence. After 3 months of ground observation, no bad effect was found on re-flying of the pilots who had undertaken laparoscopic cholelithotomy and polypectomy of gallbladder.