微创保胆取石术的临床体会(附20例报告)

Clinical experience of mini-invasive cholecystolithotomy: with a report of 20 cases

目的：探讨微创保胆取石术的适应证及一孔双视免气腹腹腔镜系统的临床应用价值。方法：回顾分析2008年5月至2012年12月为20例患者行腹腔镜联合胆道镜保胆取石术的临床资料。结果：19例成功完成保胆取石术，1例行开放腔镜胆囊切除术。手术时间30～90min，平均（55．5±25．5）min；术中出血量5～10ml；术后首次下床活动时间10～20h，平均（15±5．5）h；术后通气时间18～30h，平均（24±6．5）h；术后住院1～4d，平均（2．0±1．3）d。未发生腹腔及胆囊内出血、胆漏、肠漏、切口感染、胆管损伤等并发症。术后随访6～60个月，无结石复发，胆囊收缩功能良好。结论：腹腔镜联合胆道镜保胆取石术安全、有效，具有微创、术后康复快、并发症少、结石残留率低等优点，术前严格掌握适应证，可获得良好的疗效。

Objective：To discuss the operative indications of mini-invasive cholecystolithotomy and clinical value of one-hole double-view pneumoperitoneum-free laparoscopic surgical system. Methods：The clinical data of 20 patients with choleeystolithiasis who underwent cholecystolithotomy with one-hole double-view pneumoperitoneum-free laparoscopic surgical system and choledochoscopy from May 2008 to Dec. 2012 were retrospectively analyzed. Results：Cholecystolithotomy was successfully accomplished in 19 patients, 1 patient was given open laparoscopic cholecystectomy. The operative time was 30-90 min, mean （ 55.5 ± 25.5 ） min ; the intraoperative blood loss was 5-10 ml. The postoperative ambulation time was 10-20 h,mean （15 ±5.5） h;the anal exhaust time was 18-30 h,mean （24 ± 6.5 ） h. All patients were discharged uneventfully, the postoperative hospital stay was 1-4 d, mean （2.0 ± 1.3 ） d. No complica- tions such as hemorrhage in abdomen or gallbladder, biliary leakage,intestinal leakage, incision infection, bile duct injury or others were recorded. During the follow-up of 6-60 months, no recurrence occurred and the gallbladder contraction was well. Conclusions ： Laparo- scopic and choledochoscopic eholecystolithotomy is safe, feasible, effective and mini-invasive with advantages of quick recovery,low rate of complication and residual calculus on the basis of strict abiding operative indication.