第三代EMS超声碎石清石系统在困难性腹腔镜保胆取石术中的应用体会

The experience of the EMS third generation ultrasonic and lithotripsy system used in the complicated laparoscopic gallbladder preserving cholecystolithotomy

目的：探讨第三代EMS超声碎石清石系统在困难性腹腔镜保胆取石术中的应用价值、可行性及临床效果。方法：回顾分析19例困难性腹腔镜保胆手术患者的临床资料,对于胆道镜取出较困难的结石（直径〉2 cm或〈0.5 cm）,使用瑞士EMS第三代超声碎石清石系统直接超声粉碎后吸除或先用气压弹道碎石后再结合超声清除结石。观察手术时间、术后并发症及术后恢复情况。结果：19例患者均顺利完成腹腔镜保胆手术,一次性取石成功。手术时间49-126 min,平均（94±23.1）min;术后3-4 d出院,无一例发生胆漏。术后患者均获随访,随访3-50个月,均未见结石复发;第1、3、6个月复查B超,患者胆囊收缩功能恢复良好。结论：EMS第三代超声碎石清石系统可解决腹腔镜保胆手术中结石较大及泥沙样结石取出困难的问题,缩短了手术时间,减少了胆道黏膜的损伤,具有效率高、操作安全等优点。

Objective：To investigate the feasibility,application value and clinical effects of the application of EMS third generation ultrasonic lithotripsy system used in the complicated laparoscopic gallbladder preserving cholecystolithotomy. Methods：The clinical data of 19 cases complicated laparoscopic gallbladder preserving cholecystolithotomy were retrospectively analyzed. For the gallstones which were difficult to remove by choledochoscopy（ 〉2 cm or〈 0. 5 cm）,the stones were removed after ultrasonic lithotripsy,or pneumatic lithotripsy was performed at first and the stones were removed by ultrasound with the EMS third generation ultrasonic lithotripsy system. The operative time,postoperative complications and recovery were observed and analyzed. Results：All the laparoscopic operations were successfully completed,and all the stones were removed for the first time. The operation time was from 49 to 126 min,with an average of（94 ± 23. 1） min. The postoperative hospital stay was 3-4 d. No bile leakage was observed. All patients were followed up for3 to 50 months and no recurrence occurred. All cases received B ultrasonic check-up at 1,3 and 6 months postoperatively,and the results indicated that the contraction function of the gallbladder restored well. Conclusions：EMS third generation ultrasonic lithotripsy system can resolve the difficulties in gallbladder preserving cholecystolithotomy caused by large stones and sand stones. The system can shorten the operative time,lessen the mucosa damage,and has advantages of high efficacy and security.