腹腔镜保胆取石术和取息肉术26例报告

REPORT ON LAPAROSCOPIC REMOVAL OF CHOLECYST LITHIASIS AND POLYP IN 26 CASES

目的 :探讨腹腔镜保胆取石术和取息肉术的手术方法和适应证。方法 :2 6例病人在全麻下采用腹腔镜胆囊切除术 (L .C)的标准四戳孔 ,借助胆道镜、取石网和电热圈套器处理胆囊结石和胆囊息肉 ,胆囊壁切口用 3- 0～ 5 - 0可吸收缝针线荷包缝合或连续扣锁缝合 ,取出的胆囊结石和胆囊息肉装入标本袋从剑突下孔或脐部孔取出。Winslow孔附近常规放置两根多孔腹腔引流管观察渗漏情况。结果 :施行保胆取石术 2 4例和取息肉术 2例 ,成功 1 8例 ,中转LC5例 ,胆漏 2例 ,胆道出血 1例。腹腔引流管引流出渗出液 2 0～ 30 0ml/d ,术后 2～ 7d拔除。无中转开腹。无死亡。手术历时 (穿刺Troear到取出标本袋 ) 4 0～ 1 60min ,平均 90min。术后住院 3～ 1 0d。结论 :选择合适病人 ,确切的胆道镜检查和治疗 ,可靠的缝合胆囊壁切口 ,施行腹腔镜保胆取石术和取息肉术可行、有效、较安全。

Objective:The purpose of this paper was to discuss the methods and indications of treating the cholecyst lithiasis and polyp by laparoscopy and choledochoscopy for preservation of cholecyst.Methods: A pospective study of 26 patients of treating the cholecyst lithiasis and polyp by laparoscopy and choledochoscopy for preservation of cholecyst had been operated between Mar.2002 and Aug.2002. It was first adopted that extraction of the gall bladder stones and cholecyst polyps with choledochotomy, that the incision of the gall bladder were performed with absorbable suture 3-0～5-0 (polyglycolic acid bralded suture) by dissecting forceps and needle blocker by suturing method.Results:Twenty-one patients had completed successful cholecyst clerrance to reach the preestablished object of preservation of cholecyst in total 26 patients, 5 patients changed laparoscopic preservation of cholecyst into laparoscopic cholecystectomy. Two patients had leaked the bile juice continue 4 days and 5 days to heal up, 1 patient had the bleeding of bile duct to heal up with non-operation.Conclusion: This method is safety and feasible that had completed successful cholecyst lithiasis and polyp clearance and the incision of the gall bladder were performed with absorbable suture by the primary closure method, it was for preservation of the functional cholecyst.