经胃肠自然腔道软式内镜保胆取石术初探

A preliminary study on biliary lithotomy with gastrointestinal NOTES soft endoscope

目的初步探讨经胃肠自然腔道软式内镜保胆取石术的临床价值。方法回顾性分析2017年8月至2020年10月中国人民解放军联勤保障部队第909医院消化内科收治经胃肠自然腔道(NOTES)软式内镜保胆取石术39例患者的临床资料,包括手术时间、手术并发症、随访情况等。结果39例患者均顺利完成经胃肠NOTES软式内镜保胆取石术,手术时间完成时间60~240 min,中位时间94 min。其中经胃NOTES完成24例,经肠NOTES完成15例。术后有12例出现不同程度腹痛,有1例术后出现胆瘘(予以腹腔镜胆囊切除术)、2例闭合不佳(予以内镜下再次闭合处理)。术后随访截至2020年11月,失访2例(5.12%),随访37例。随访患者的胆囊功能均良好,其中1例(2.56%)发现结石残留,3例(8.10%)见胆固醇结晶形成。结论经胃肠NOTES软式内镜保胆取石术安全可行,疗效好,符合微创理念。但如何做到取净结石,且减少结石复发,仍需进一步探索,同时其远期疗效也需进一步随访观察。

Objective Objective to explore the clinical value of soft endoscopic choledocholithotomy through natural orifices(NOTES).Methods from August 2017 to October 2020,the clinical data of 39 patients with gastrointestinal NOTES soft endoscopic choledocholithotomy were retrospectively analyzed,including the operation time,surgical complications and follow-up.Results All of the 39 patients successfully completed the gastrointestinal NOTES soft endoscopic choledocholithotomy without conversion to laparoscopy or open surgery.The operation time was 60~240 min,and the median time was 94min.Among them,24 cases were completed by gastric NOTES and 15 cases were completed by intestinal NOTES.There were 12 cases of abdominal pain,1 case of biliary fistula was treated by laparoscopic cholecystectomy,2 cases of poor closure were treated by endoscopic closure.Up to November 2020,2 cases(5.12%)were lost and 37 cases were followed up.The gallbladder function was good in all patients.Residual stones were found in 1 cases(2.56%)and cholesterol crystals were found in 3 cases(8.10%).Conclusion It is safe,feasible,effective and in line with the concept of minimally invasive surgery.However,how to remove the stones and reduce the recurrence of stones still need further exploration,and the long-term efficacy also needs further follow-up observation.