腹腔镜联合胆道镜保胆取石(息肉)术的临床分析(附1006例报告)

The clinical analysis of combined laparoscopic and choledochoscopiclithotomy or polypectomy with gallbladder preservation:with a report of 1006 cases

目的:探讨腹腔镜联合胆道镜行微创保胆取石(息肉)术的临床应用价值。方法:回顾分析2007年1月至2012年1月为1 039例患者行腹腔镜、胆道镜联合保胆取石(息肉)术的临床资料。结果:1 006例应用腹腔镜、胆道镜成功取净结石、息肉;33例中转行腹腔镜胆囊切除术。695例结石患者中单发176例,多发519例;结石数量1～407颗,平均(14±2.3)颗;直径0.1～3.3 cm,平均(1.1±0.12)cm。311例胆囊息肉样病变,单发79例,直径0.5～2.2 cm,平均(0.7±0.15)cm;多发232例,直径0.4～1.0 cm,平均(0.6±0.13)cm。手术时间30～125 min,平均(50±6)min。术后平均住院4 d。术中、术后均无并发症发生。术后随访0.5～5年,结石复发3例,复发率0.43%,息肉(胆固醇性)复发11例,复发率3.54%。结论:腹腔镜联合胆道镜保胆取石(息肉)术安全、可行,可提高结石取净率及保胆成功率。

Objective：To discuss the clinical application value of combined laparoscopic and eholedoehoscopidithotomy or polypectomy with gallbladder preservation. Methods ：The clinical data of 1 039 cases who underwent combined laparoseopic and eholedochoscopiclithotomy or polypectomy with gallbladder preservation from Jan. 2007 to Jan. 2012 were retrospectively analyzed. Results： Calculi or polyps in 1 006 cases were successfully removed or resected by laparoscope and choledoehoscope. Thirty-three cases were converted to laparoscopic cholecystectomy. In the 695 cases of cholecystolithiasis, stones were single in 176 cases and multiple in 519 cases,with the number ranging from l to 407 （ 14 ±2.3） ,the diameter of stones ranged from 0.1 to 3.3 （ 1.1 ±0.12） cm. In the 311 cases of gallbladder polyps ,79 cases were single with the diameter ranging from 0.5 to 2.2 （0.7 ± 0.15 ） cm ,232 cases were multiple with the diameter ranging from 0.4 to 1.0 （0.6 ± 0.13） cm. The operation time was ranging from 30 to 125 （50 ± 6） min. The mean postoperative hospitalization was 4 d. No inta- or post-operative complications occurred. All patients were followed up from 0.5 to 5 y. Cholecystolithiasis recurred in 3 cases and the recurrence rate was 0.43 %. Gallbladder polyps （cholesterol） recurred in 11 cases and the recurrence rate was 3.54%. Conclusions ： Laparoscopy combined with choledochoscope for removing calculi （polyp） and conserving gallbladder is safe and feasible, which could increase the rate of removing calculi and preserving gallbladder.