腹腔镜联合胆道镜保胆取石术治疗胆囊结石伴胆囊炎的体会

Experience of laparoscopic combined with choledochoscopic gallbladder preservation stone extraction in the treatment of gallstone complicated with cholecystitis

目的探讨腹腔镜联合胆道镜保胆取石术治疗胆囊结石伴胆囊炎的临床价值。方法 36例胆囊结石伴胆囊炎患者均采用腹腔镜辅助定位,右上腹壁小切口将胆囊底提出腹壁外,切开胆囊底部,应用胆道镜进行取石,保留胆囊,观察治疗效果。结果 36例患者成功进行了保胆取石术,手术操作时间70-220 min。手术难易度不等,胆囊体内结石容易取出,胆囊颈部结石较难取出,胆囊管结石最难取出。患者术后彩超复查胆囊功能恢复良好,短期内未见胆囊结石复发。结论腹腔镜联合胆道镜保胆取石术治疗胆囊结石伴胆囊炎疗效可靠,保留了有功能的胆囊,具有临床推广应用价值。

Objective To investigate clinical value of laparoscopic combined with choledochoscopic gallbladder preservation stone extraction in the treatment of gallstone complicated with cholecystitis. Methods A total of 36 patients with gallstone complicated with cholecystitis received laparoscope-assisted localization, the bottom of gallbladder is pulled out of abdominal wall through a small incision in the right upper abdominal wall, and choledochoscopic gallbladder preservation stone extraction was applied through opened bottom. Curative effect was observed. Results All the 36 patients received successful gallbladder preservation stone extraction, and their operation time was 70-220 min. Extraction of stone inside body of gallbladder was easy, followed by hard extraction of stone in neck of gallbladder. It is hardest for extraction cystic duct stone. Postoperative examination by color Doppler ultrasound showed good rehabilitation in patients, without short-term recurrence of gallstone. Conclusion Combination of laparoscopic and choledochoscopic gallbladder preservation stone extraction provides creditable effect in treating gallstone complicated with cholecystitis, and preserves gallbladder function. This method contains value for clinical promotion and application.