摘要
目的:探讨三孔法腹腔镜联合胆道镜保胆取石术的应用价值、适应证、手术技巧及临床疗效。方法:回顾分析2010年10月至2013年6月96例胆囊结石患者的临床资料,均行三孔法腹腔镜联合胆道镜完全腹腔内微创保胆取石术。结果:96例手术均获成功,无一例中转腹腔镜胆囊切除术或腹腔外微创保胆取石术。术中出血量5~10 ml,平均(6.0±1.1)ml;手术时间98~225 min,平均(121.8±13.2)min。术后无残留结石、出血、胆漏、腹腔感染、胆总管继发结石等并发症发生。术后住院4~7d,平均(4.5±0.6)d,术后1周复查B超,无结石残留。出院后口服熊去氧胆酸、消炎利胆片3~6个月。95例患者随访4~24个月,未见结石复发,无明显消化道症状,术后3个月复查B超提示胆囊收缩功能良好。结论:三孔法腹腔镜联合胆道镜保胆取石术安全、有效,具有患者创伤小、康复快、并发症少、手术成功率高等优点,是微创保胆取石术的理想手术方法,值得推广应用。其关键是把握适应证,术后预防性用药,同时术者需熟练掌握胆道镜技术及腹腔镜下切开、缝合、打结技术。
Objective: To discuss the clinical value,indications,operative skills and treatment effect of three-port laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy. Methods: The clinical data of 96 patients with gallbladder stones,who underwent three-port mini-invasive preservation of gallbladder and removal of calculi in the peritoneal cavity by laparoscope combined with choledochoscope,from Oct. 2010 to Jun. 2013 were retrospectively analyzed. Results: Three-port total endoscopic minimally invasive gallbladder-preserving cholelithotomy was performed successfully in 96 cases,and no case was converted to laparoscopic cholecystectomy or minimally invasive laparotomy gallbladder-preserving cholelithotomy. Intraoperative blood loss was 5-10 ml,mean( 6. 0 ± 1. 1) ml. The operative time was 98-225 min,mean( 121. 8 ± 13. 2) min. No complications such as residual calculi,hemorrhage,bile leakage,abdominal infection or secondary choledocholith occurred. The postoperative hospital stay was 4-7 d,mean( 4. 5 ± 0. 6) d. B-ultrasonography was performed in 1 week and showed no residual stones. All the patients took ursodeoxycholic acid and Xiaoyan Lidan tablet for 3-6 months postoperatively. 95 patients were followed up from 4 to 24 months,and no recurrence occurred,no obvious digestive tract symptoms were observed. The contractile function of gallbladder was favorable which was evaluated by type-B ultrasonic examination 3 months after surgery. Conclusions: Three-port total endoscopic minimally invasive gallbladder-preserving cholelithotomy is safe,effective,mini-invasive,of quick recovery,has few complications,and a high rate of success,and can be regarded as an ideal operation method for gallbladder-preserving cholelithotomy. The key of the operation should be appropriate selection of cases and preventive using drugs. Furthermore,surgeons should master the skills of choledochoscopy,laparoscopic incision,suture and ligation.
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