三孔法腹腔镜联合胆道镜保胆取石术的临床应用

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。

Clinical application of three-port laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy

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 un-derwent 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,ab-dominal infection or secondary choledocholith occurred. The postoperative hospital stay was 4-7 d, mean （4.5 ± 0.6） d. B-ultrasonogra- phy 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 symp-toms were observed. The contractile function of gallbladder was favorable which was evaluated by type-B ultrasonic examination 3 months after surgery. Conclnsions：Three-port total endoscopic minimally invasive gallbladder-preserving cholelithotomy is safe, effec-tive, mini-invasive, of quick recovery, has few complications, and a high rate of success, and can be regarded as an ideal operation meth- od 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.