腹腔镜联合胆道镜在保胆取石（息肉切除）术中的应用

Application of Laparoscopic Combined with Choledochoscopic Lithotomy or Polypectomy with Gallbladder Preservation

[目的]探讨腹腔镜联合胆道镜保胆取石（息肉切除）术的临床应用价值.[方法]将本院2008年12月至2009年11月行腹腔镜联合胆道镜保胆取石（息肉切除）术并有完整随访资料的149例患者分为胆囊结石组（A组）、胆囊结石合并息肉组（B组）、胆囊息肉组（C组）;并对临床资料进行回顾性分析.[结果]全部病例均顺利行腹腔镜联合胆道镜保胆取石（息肉切除）术,术后1例患者出现腹壁蜂窝织炎,经治疗后痊愈.1例患者出现右下肢深静脉血栓,经保守治疗而愈.术后随访52～63个月,A组内单发结石与多发结石分别复发1例（3.33％）、18例（23.68％）,差异有统计学意义（P ＜0.05）.A组结石复发19例（17.92％）,B组结石复发7例（43.75％）,差异有统计学意义（P ＜0.05）.B组息肉复发1例（6.25％）,C组息肉复发1例（3.70％）,差异无统计学意义（P＞0.05）.[结论]腹腔镜联合胆道镜保胆取石（息肉切除）术安全、微创、有效;胆囊结石合并息肉不推荐行保胆取石（息肉切除）术.

[Objective]To explore the clinical application value of laparoscopic combined with choledochoscopic lithotomy or polypectomy with gallbladder preservation.[Methocds] Totally 149 patients undergoing laparoscopic combined with choledochoscopic lithotomy or polypectomy with gallbladder preservation who had complete follow-up data in our hospital from Dec.2008 to Nov.2009 were divided into cholecystolithiasis group（group A）,cholecystolithiasis with polyps group（group B） and gallbladder polyps group（group C）.Clinical data were analyzed retrospectively.[Results]All patients underwent laparoscopic combined with choledochoscopic lithotomy or polypectomy with gallbladder preservation smoothly.One patient had cellulites of abdominal wall after operation and was cured after treatment.One patient had right lower extremity deep vein thrombosis and was cured with expectant treatment.During the follow-up for 52～63 months,1 patient（3.33％） had the recurrence of single calculi and 18 patients（23.68％） had multiple calculi in group A,and there were significant differences（P ＜0.05）.One patient（6.25 ％） in group B had the recurrence of polyps and 1 patient（3.70 ％） in group C had the recurrence of polyps,but there was no significant difference（P ＞0.05）.[Conclusion] Laparoscopic combined with choledochoscopic lithotomy or polypectomy with gallbladder preservation is safe,minimally invasive and effective.But lithotomy or polypectomy with gallbladder preservation is not recommended for cholecystolithiasis with polyps.