腹腔镜联合胆道镜保胆取石术25例临床分析
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摘要
背景：胆囊结石在世界范围来讲都是一常见病、多发病,而西方国家此病尤甚。关于胆囊结石的治疗方法和手段众多,诸如碎石、溶石、排石和手术等。但主要的治疗方法仍是外科手术。胆囊切除术一直被奉为治疗胆囊结石的“金标准”。一方面,近年来内镜、腹腔镜等微创外科技术已经取得了长足的发展；另一方面对胆囊功能的了解不断加深,以及胆囊切除后带来的诸如消化不良、胆总管结石甚至于结肠癌等并发症有了新的认识,保留胆囊取出结石的意识和理念日渐增强。所以,“保胆取石”的呼声也日渐强烈,并有学者为此而不懈努力。即使在大型医院和医学中心,对于经验丰富的外科医师而言,选择何种手术方式治疗胆囊结石,仍为颇具争议的难题。
目的：探讨腹腔镜联合胆道镜行保留胆囊取石术对胆囊结石的治疗效果,进而讨论保胆取石术的临床意义。
方法：收集山东大学齐鲁医院2008年3月至2012年11月间行腹腔镜联合胆道镜行保胆取石术治疗胆囊结石25例患者病例资料,并电话追踪随访及行B超检查。
结果：25例中24例手术成功,1例中转行腹腔镜胆囊切除术,术后发生腹腔感染1例,无胆漏等严重并发症出现,出院后电话追踪随访并行B超检查,5例出现胆囊结石复发。
结论：腹腔镜联合胆道镜行保胆取石术具有保存胆囊功能、创伤小、恢复快、安全性高等优点,是一种安全可行的治疗胆囊结石的微创手术疗法,但存在较高胆囊结石复发风险。在实施保胆手术时,应严格掌握适应证。
Background:The gallstone in the world scope is a common and frequently-occurring disease, especially in the western countries. The treatment methods of gallbladder stones are numerous, such as lithotripsy, lithodialysis, removing and surgery, etc. But the main treatment is surgery. Cholecystectomy has long been regarded as the "gold standard" in the treatment of gallbladder calculi. On the one hand, endoscopic and laparoscopic minimally invasive surgery technology has made great development in recent years; On the other hand, the understanding of the function of gallbladder is deepening and some scholars have a new understanding of various complications after Cholecystectomy, such as indigestion, common bile duct calculi and colon cancer, so the consciousness of preserving the gallbladder is growing. Therefor, the voice of " gallbladder-preserving cholecystolithotomy " is more and more strong, and some scholars make unremitting efforts for this. Even in large hospitals and medical centers, for the most experienced surgeons,,it is still a controversial problem that choosing what kind of surgery of gallstones.
Objective:To discuss the clinical significance of gallbladder-preserving cholecystolithotomy using laparoscopy combined with choledochoscopy by investigating its treatment effect for gallbladder stone.
Method:25patients underwent cholecystolithotomy with gallbladder preservation in Qilu Hospital of Shandong University from March2008to November2012,and they were followed up and taken B ultrasound examination.
Results:In25cases,24cases of operations were successful, and1case turned to laparoscopic cholecystectomy(LC). Postoperative abdominal infection occurred in1case, and others had no serious complications.None of patients had bile leakage. All of patients were followed up by telephone and taken B ultrasound examination.5cases of patients had gallbladder stone recurred.
Conclusions:Gallbladder-preserving cholecystolithotomy using laparoscopy combined with choledochoscopy is a minimally invasive method to cure the gallbladder stone with preservation of gallbladder function, little injury and pain, and high safety.However it has a higher gallbladder stone recurrence risk,and strict indications should be held.
目的：探讨腹腔镜联合胆道镜行保留胆囊取石术对胆囊结石的治疗效果,进而讨论保胆取石术的临床意义。
方法：收集山东大学齐鲁医院2008年3月至2012年11月间行腹腔镜联合胆道镜行保胆取石术治疗胆囊结石25例患者病例资料,并电话追踪随访及行B超检查。
结果：25例中24例手术成功,1例中转行腹腔镜胆囊切除术,术后发生腹腔感染1例,无胆漏等严重并发症出现,出院后电话追踪随访并行B超检查,5例出现胆囊结石复发。
结论：腹腔镜联合胆道镜行保胆取石术具有保存胆囊功能、创伤小、恢复快、安全性高等优点,是一种安全可行的治疗胆囊结石的微创手术疗法,但存在较高胆囊结石复发风险。在实施保胆手术时,应严格掌握适应证。
Background:The gallstone in the world scope is a common and frequently-occurring disease, especially in the western countries. The treatment methods of gallbladder stones are numerous, such as lithotripsy, lithodialysis, removing and surgery, etc. But the main treatment is surgery. Cholecystectomy has long been regarded as the "gold standard" in the treatment of gallbladder calculi. On the one hand, endoscopic and laparoscopic minimally invasive surgery technology has made great development in recent years; On the other hand, the understanding of the function of gallbladder is deepening and some scholars have a new understanding of various complications after Cholecystectomy, such as indigestion, common bile duct calculi and colon cancer, so the consciousness of preserving the gallbladder is growing. Therefor, the voice of " gallbladder-preserving cholecystolithotomy " is more and more strong, and some scholars make unremitting efforts for this. Even in large hospitals and medical centers, for the most experienced surgeons,,it is still a controversial problem that choosing what kind of surgery of gallstones.
Objective:To discuss the clinical significance of gallbladder-preserving cholecystolithotomy using laparoscopy combined with choledochoscopy by investigating its treatment effect for gallbladder stone.
Method:25patients underwent cholecystolithotomy with gallbladder preservation in Qilu Hospital of Shandong University from March2008to November2012,and they were followed up and taken B ultrasound examination.
Results:In25cases,24cases of operations were successful, and1case turned to laparoscopic cholecystectomy(LC). Postoperative abdominal infection occurred in1case, and others had no serious complications.None of patients had bile leakage. All of patients were followed up by telephone and taken B ultrasound examination.5cases of patients had gallbladder stone recurred.
Conclusions:Gallbladder-preserving cholecystolithotomy using laparoscopy combined with choledochoscopy is a minimally invasive method to cure the gallbladder stone with preservation of gallbladder function, little injury and pain, and high safety.However it has a higher gallbladder stone recurrence risk,and strict indications should be held.
引文
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