胆囊结石分级分期治疗策略——附441例保胆手术经验总结与体会

Stage and grade-based surgical strategy for gallstone disease: the experiences of 441 cases of gallbladderpreserving cholecystolithotomy

目的回顾性总结使用硬质胆囊镜（硬镜）进行保胆手术治疗胆囊结石的经验与体会,并制定胆囊结石分级分期治疗策略（唐都经验/标准）。方法对该科2009年12月-2012年12月441例行硬镜取石保胆术患者进行回顾性分析。结果 441例胆囊结石患者均行手术治疗,其中11例失访,失访率为2.4%。6例患者出现术后并发症,其中胆囊结石复发2例（0.47%）,胆囊周围积液3例（0.7%）,胆漏1例（0.23%）,其余424例效果均满意。结论取石保胆术是一种尚有争议,但逐渐被认可的手术治疗方式,可以成为治疗胆囊结石的主要治疗方法。笔者制定的＂GUW＂胆囊结石分级分期治疗策略（唐都经验/标准）有望成为这一治疗方式的评价体系标准。

【Objective】To summarize our experiences of gallbladder-preserving cholecystolithotomy by rigid cholecystoscope, and set up the surgical strategy for gallstone disease based on the staging and grading system（Tangdu＇s standard）. 【Methods】The hospital records of 441 cases of patients with gallstone, who underwent gallbladder-preserving cholecystolithotomy were retrospectively reviewed from December 2009 to December 2012 in Department of general surgery, Tangdu Hospital. 【Results】441 cases of gallstone patients were treated by surgical operation. 11 cases were lost to follow-up, the loss ratio of follow-up is 2.4%. Postoperative complications happened in 6 patients, including gallbladder stones recurrence in 2 cases（0.47%）, pericholecystic fluid in 3 cases（0.7%）, bile leakage in 1 case（0.23%）.【Conclusion】Gallbladder-preserving cholecystolithotomy is a surgical procedure, though controversial, it is gradually accepted by experts. The ＂GUW＂ staging and grading system（Tangdu＇s standard） was set up to be one of the new treatment standards for gallstone disease.