4571例腹腔镜联合硬质肾镜微创保胆取石(息肉)手术体会

Experience of 4571 Cases of Laparoscopic Combined With Hard Kidney Lens Minimally Invasive Gallbladder Stone Removal(Polyps)

目的探讨4 571例腹腔镜、硬质肾镜联合微创保胆取石(息肉)手术体会。方法回顾性分析我院2011年1月~2015年12月共4 571例腹腔镜、硬质肾镜联合微创保胆取石(息肉)手术,其中胆囊结石4 082例,胆囊息肉489例的临床资料,分析术后出现:(1)术后胆囊结石复发;(2)术后胆漏;(3)术中结石掉入胆总管的临床资料。结果术后胆漏18例,术后8 h^4 d出现发热、腹痛(以右侧腹痛为明显,有腹膜炎体征),经彩色多普勒检查均提示胆囊周围有积液,18例经再次腹腔镜探查证实为胆囊切口处漏,均予腹腔镜下胆囊切口缝合,腹腔冲洗后治愈。18例全部出现在开展该术式的第1年。结论腹腔镜联合硬质肾镜微创保胆取石(息肉)术野宽广清晰、通道便捷、取石方便、结石(息肉)取尽率高等优点。重视术前核磁共振胰胆管水成像(MRCP)检查,明确有无肝外胆管结石。取尽结石(息肉),不残留血块、取尽壁间结石是减少术后复发的最常见方法。术后规律服用溶石药物是降低结石复发的重要手段。

Objective To investigate the operation experience of 4 571 cases of laparoscopic and hard renal lens combined with minimally invasive gallbladder preserving surgery（polyps）. Methods A retrospective analysis of our hospital from January 2011 to December 2015 a total of 4 571 cases of laparoscopic combined with hard nephrolithotomy minimally invasive gall preserving lithotomy（polyps） surgery, gallbladder stones which 4 082 cases, gallbladder polyps 489 cases of clinical data, analysis of postoperative：（1） Postoperative recurrence of cholecystolithiasis.（2） Postoperative bile leakage.（3） Intraoperative stones fall into the common bile duct of clinical data. Results Postoperative bile leakage in 18 cases, postoperative 8 h to 4 days fever, abdominal pain（with right abdominal pain obviously, there are signs of peritonitis）, by color Doppler examination showed around the gallbladder hydrops, 18 cases with laparoscopic exploration again confirmed to the gallbladder incision leakage, were treated with laparoscopic gallbladder incision suture, peritoneal lavage after cure. All 18 cases appeared in the 1 year of the operation. Conclusion Laparoscopic combined with hard kidney stone minimally invasive gallbladder preserving stone（polyps） no hirohiro clear, easy access, easy access to stone, stone（polyps） to take advantage of the high rate of. Preoperative magnetic resonance imaging（MRCP） in patients with extrahepatic bile duct stones. The stone（polyps）, no residual blood clots, the wall of stones is the most common method to reduce postoperative recurrence. Postoperative regular use of soluble stone drugs is an important means to reduce the recurrence of stones.