腹腔镜联合胆道镜微创保胆息肉摘除术156例临床分析

Clinical analysis on 156 cases of gallbladder polyps treated with minimally invasive laparoscopy combined with choledochoscopy

目的：探讨腹腔镜、靼道镜（双镜）联合微创保胆息肉摘除术的指征、方法及临床价值。方法：回顾性分析2009年3月一2012年3月156例患者实施双镜联合微创保胆息肉摘除术的临床资料。于胆曩底部无血管区电切开10mm，在胆道镜引导下热活检钳摘除息肉。确认无息肉残留并观察到胆汁涌入胆囊通畅后，以甲硝唑冲洗胆囊，胆囊切口用可吸收线全层逢合，不置胆囊造瘘管和腹腔引流管。结果：156例中1例改行腹腔镜胆囊切除术，均痊愈出院。手术时间42～126min，平均84min。132例随访3～36月，B超示胆囊大小、形态正常，末见息肉复发。结论：双镜联合微创保胆息肉摘除术治疗胆囊息肉疗效理想，创伤小，既保留了有功能的胆囊，又摘除了息肉。术中须常规行快速病理检查，对无功能胆囊及恶变者行腹腔镜胆囊切除术。

Objective： To discuss the indirection, methods and clinical value of combined la- paroscopy and choledochoscopy for remaining gallbladder polyps. Methods： 156 patients with gall- bladder polyps were retrospectively analyzed who were treated with minimally invasive removal ofgallbladder polyps from march 2009 to march 2012, by using laparoscopy combined with choledo- choscopy. The incision on the fundus of gallbladder was made about 10mm, then gallbladder polyps removed with hot biopsy forceps under the observation with choledochoscope. After clearly remov- ing all polyps, the gallbladder was washed with metronidazole, and the incision of gallbladder was sewed using absorable thread, without placement of gallbladder fistulation tube and abdominal cavity drainage tube. Results： The operative time was from 42 min to 126 min, average84 min. The pa- tients were cured without infections. 156 patients with gallbladder polyps who were treated with minimally invasive removal of gallbladden polyps, and one patient underwent laparoscopic cholecys- tectomy. With the follow-up of 3 N36 months, 132 patients were examined under B ultrasound, normal gallbladder contractility and no relapses was shown in those patients. Conclusion： Mini- mally invasive choledochoscopy is curable for treatment of gallbladder polyps. However, the indica- tions have to be restricted. Otherwise, laparoscopic cholecystectomy has to be taken.