腹腔镜联合胆道镜保胆取石术5年回顾分析(附360例报告)

5-year retrospective analysis of laparoscopic combined choledochoscopic gallbladder-preserving cholelithotomy: with a report of 360 cases

目的：探讨腹腔镜联合胆道镜保胆取石术的应用价值、适应证、手术技巧及临床疗效。方法：回顾分析2008年1月至2013年12月为360例胆囊结石患者行腹腔镜联合胆道镜保胆取石术的临床资料。结果：360例手术均获成功,术中出血量5-10 ml,平均（7.0±1.2）ml;手术时间36-176 min,平均（48.5±17.4）min。术后无残留结石、出血、胆漏、腹腔感染等并发症发生。术后住院2-3 d。随访5年,236例获得随访,随访率65.6%;其中12例结石复发,复发率5.08%。结论：腹腔镜联合胆道镜保胆取石术后复发率较低,方法简单,手术安全、可行,是保留胆囊功能的有效方法。

Objective： To discuss the clinical value,indications,operative skills and treatment effect of laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy. Methods： The clinical data of 360 patients who suffered from cholecystolithiasis and underwent laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy from Jan. 2008 to Dec. 2013 were retrospectively analyzed. Results： Operations were successful in all patients. Intraoperative blood loss was 5-10 ml,with the average of（ 7. 0 ±1. 2） ml; mean operative time was（ 48. 5 ± 17. 4） min（ range,36-176 min）. There were no residual stones,bleeding,bile leakage,intra-abdominal infections or other complications. Postoperative hospital stay was 2-3 d. 5-year follow-up rate was 65. 6%（ 236 /360）.Stone recurrence was found in 12 cases（ 5. 08%）. Conclusions： The recurrence rate of cholecystolithiasis after laparoscopic combined choledochoscopic gallbladder-preserving cholelithotomy is lower. The method is much simple,safe and feasible,and it is an effective method of reserving the function of the gallbladder.