内镜联合钬激光微创保胆取石治疗胆囊结石的体会

Clinical Experience on Treatment of Gallstone with Minimaly Invasive Cholecystolithotomy: Joint Application of Endoscopic Surgery and Holmium Laser

目的总结分析内镜联合钬激光微创保胆取石治疗胆囊结石的临床经验。方法回顾分析内镜微创保胆取石患者82例的临床资料,其中胆囊底可提拉至腹部切口外(排空腹腔气体)患者45例,采用腹腔镜辅助下小切口联合胆道镜保胆取石术;胆囊周围粘连严重患者37例,采用腹腔镜联合胆道镜保胆取石术。胆囊成块型结石65例,砂砾型结石17例。结果 82例手术均保胆取石成功,成功率为100%,无中转胆囊切除。术后并发症7例:切口感染5例,肺部感染2例,均治愈。术后随访12～50个月,平均(20.39±9.3)个月,复发5例(6.09%)。结论严格掌握手术指征的情况下,内镜微创保胆取石治疗胆囊结石具有创伤小、并发症少,取石率高、残石率低等优点;联合钬激光可处理胆囊管嵌顿结石,避免胆囊切除。

Objective To summarize and analyze the clinical experience on the treatment of gallstone with minimally invasive cholecystolithotomy（endoscopic surgery ＋ holmium laser）.Methods The clinical data of 82 gallstone patients given minimally invasive cholecystolithotomy（endoscopic surgery ＋ holmium laser） were retrospectively analyzed. Among them,34 people were associated with holmium laser lithotripsy,65 people had block stones in gallbladder and 17 people had gravel stones in gallbladder. All the 82 patients were treated successfully,indicating a success rate of100%.Results All the patients were given a successful operation,and no one was transferred to cholecystectomy. Postoperative complications occurred to 7 people in total： infection of incisional wound in 5 cases and pheumonia in 2 cases. Eventually,all the complications werecured. The follow up lasted for 12-50 months（20. 39 ± 9. 27 months on average）. Stone recurrence occurred in 5 cases（6. 09%）.Conclusions With a strict control of surgical indications,endoscope-assisted minimally invasive treatment of gallstones has many advantages： less trauma,low occurrence rate of complications,high successful rate of cholecystolithotomy and small residual stone rate.The combination with holmium laser can be used to treat cystic duct incarcerated stones to avoid cholecystectomy.