肾镜联合腹腔镜微创保胆取石术的临床体会

The clinical experience of nephroscope assisted laparoscopic gallbladder-preserving cholelithotomy

目的:探讨肾镜联合腹腔镜微创保胆取石术的临床价值与手术技巧。方法:回顾分析2012年5月至11月为104例胆囊结石患者在腹腔镜配合下应用肾镜直视取石的临床资料。结果:101例成功施行保胆取石术,3例因胆囊管无胆汁涌出、术中胆道造影提示胆囊管堵塞中转行腹腔镜胆囊切除术;手术时间平均(71±5.72)min,无结石残留、胆漏、出血等并发症发生。结论:肾镜联合腹腔镜微创保胆取石术具有肾镜术野宽广清晰、通道便捷、取石方便、结石取净率高等优点,尤其颈部结石嵌顿患者,应用推、挤、吸、夹等方式可将结石松动,通道还可使用超声碎石等技术,值得推广应用。

Objective：To study the value and surgical skills of nephroscope assisted laparoscopic gallbladder-preserving chole- lithotomy. Methods：The clinical data of 104 patients with gallbladder stones who underwent nephroscope assisted laparoscopie gallblad- der-preserving cholelithotomy from May 2012 to Nov. 2012 was retrospectively analyzed. Results：One hundred and one operations were successful and 3 operations were converted to laparoseopic cholecystectomy for blockage within the cystic duct indicated by intraopera- tive eholangiography. The mean time of operation was （71 _＋ 5.72） rain. No complications such as residue of stones, bile leakage or hemorrhage occurred. Conclusions： Nephroscope assisted laparoscopic gallbladder-preserving eholelithotomy has advantages of wider and clearer operative field,is more effective in cleaning stones from gallbladder and more eonverient in constructing surgical channel, es- pecially in removing blockage within gallbladder neck by pushing, suction and clipping. Additionally, ultrasonic lithotripsy can be ap- plied in the operation. Thus, this kind of Operative method is worthy to be widely, popularized.