完全腹腔镜胆囊颈部结石嵌顿保胆取石术18例临床分析

目的:探讨完全腹腔镜胆囊颈部结石嵌顿保胆取石术的手术方法及临床疗效。方法:回顾分析2009年12月至2013年12月为18例胆囊结石患者行完全腹腔镜保胆取石术的临床资料,胆囊颈部结石嵌顿采取切开胆囊颈部取石。结果:16例(88.9%)保胆取石成功,2例(11.1%)未能成功保胆,行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。胆囊颈部切开取出的嵌顿结石为质硬、黄色或一面为黄色另一面为黄黑色的圆形结石,直径0.3~0.5 cm,平均(0.39±0.06)cm。手术时间120~185 min,平均(136.5±16.0)min;术中出血量30~60 ml,平均(40.0±8.4)ml。术后无出血、明显胆漏、急性胆管炎、胆总管继发结石、胰腺炎等并发症发生。住院4~8 d,平均(5.0±1.2)d。16例保胆患者术后随访6个月~4年,胆囊无残石,无结石复发,胆囊壁厚度正常,无明显消化道症状。结论:完全腹腔镜保胆取石术中切开胆囊颈部取嵌顿结石安全、可行,效果良好,是处理胆囊颈部嵌顿结石的有效方法。

Clinical analysis of 18 cases of total laparoscopic gallbladder-preserving cholecystolithotomy for calculus impacted in neck of gallbladder

Objective：To evaluate the operative method and treatment effect of total laparoscopic gallbladder-preserving chole- cystolithotomy for calculus impacted in neck of the gallbladder. Methods ： From Dec. 2009 to Dec. 2013,18 patients with cholecystolithi- asis underwent total laparoscopic gallbladder-preserving eholecystolithotomy in author＇ s hospital, and impacted calculi in neck of the gallbladder were encountered and removed through incision of the gallbladder neck. The clinical data of these patients were retrospec- tively analyzed. Results： Total laparoscopic gallbladder-preserving cholecystolithotomy was performed successfully in 16 patients （88.9%）. Two patients （11.1%） were treated with laparoscopic eholecysteetomy （LC）. 4-port procedure was applied in all cases. The impacted calculi which were removed through the incision of gallbladder neck were hard, round, yellow or yellow on one side and dark yellow on the other side,with diameter of 0.3 to 0.5 cm,the mean was （0.39 ± 0.06） cm. The operative time was 120-185 min, mean （ 136.5 ± 16.0） min;and intraoperative blood loss was 30-60 ml,mean （40.0 ± 8.4） ml. There were no significant postoperative complications such as bleeding, obvious bile leakage, acute eholangitis, secondary choledocholithiasis, acute pancreatitis. The hospital stay was 4-8 d, mean （5.0 ± 1.2 ） d. 16 patients who underwent gallbladder-preserving choleeystolithotomy were followed up for 6 months to 4 years, and no residual stone or recurrence of calculi was found. The thickness of the gallbladder wall was normal and no ob- vious digestive tract symptoms were observed. Conclusions： Incision of gallbladder neck for removal of impacted calculus during total laparoscopic gallbladder-preserving cholecystolithotomy is safe ,feasible and associated with satisfactory results. It is one of the effective methods dealing with impacted calculus in neck of the gallbladder for gallbladder-preserving cholecystolithotomy.