军事飞行人员腹腔镜保胆取石术及其远期疗效观察

Laparoscopic cholecystolithotomy for military pilots and long-term effect

目的分析军事飞行人员腹腔镜微创保胆取石术适应证、术后远期疗效以及对术后飞行工作的影响。方法收集2011年4月—2015年11月空军特色医学中心收治的9例飞行人员行腹腔镜下保胆取石和取息肉术临床资料,统计术前症状、结石数目和大小、结石性质、术后有无不适及复发、对飞行工作的影响。结果 9例患者中7例均为1枚结石,其中2例合并胆固醇性息肉,1例合并胆总管结石;1例为2枚结石;1例为单纯胆固醇性息肉。9例患者均行胆囊底部切开取石及取息肉术,胆囊切口采用聚丙烯不可吸收缝线缝合3例,采用3-0可吸收线缝合6例。随访4.5~9年,术后累计胆结石复发率37.5%(3/8)。1例因血管性头痛停飞,其余均继续飞行或到龄退休。结论选择性地施行腹腔镜保胆取石(息肉)术有利于保留胆囊功能及飞行人员术后复飞。

Objective To analyze the indications,long-term effect and the influence of surgery on flight after laparoscopic cholecystolithotomy in military pilots.Methods The clinical data of 9 pilots who underwentlaparoscopic cholecystolithotomy and polypectomy in our hospital between April 2011 and November 2015 was collected.The preoperative symptoms,number and size of stones,nature of stones,discomfort and recurrence,and the impact on flight were analyzed.Results Among the 9 cases,7 had only one stone,including 2 cases with cholesteric polyps and 1 case with choledocholithiasis.One case had two stones and another case developed simple cholesteric polyps.All the 9 patients underwent cholecystolithotomy and polypectomy.Three cases were sutured with polypropylene non absorbable suture and 6 with 3-0 absorbable suture.After 4.5-9 years of follow-up,the cumulative recurrence rate of gallstones was 37.5%(3/8).One case stopped flying because of vascular headache,while the rest were qualified for flying.Conclusion Selective laparoscopic cholecystolithotomy(polyp)can contribute to the preservation of gallbladder function and the recovery of pilots.