合并常见慢性病患者微创保胆术175例报告

目的:探讨腹腔镜联合胆道镜保胆取石(息肉)术治疗胆囊结石(息肉)合并常见慢性病患者的安全性及手术疗效。方法:回顾分析2009年2月至2012年2月为175例胆囊结石(息肉)合并常见慢性病患者行腹腔镜联合胆道镜保胆取石(息肉)术的临床资料。结果:3例因术中判断胆囊功能较差、2例因术中胆囊息肉基底部出血不止中转腹腔镜胆囊切除术,余均顺利完成保胆取石(息肉)术。手术时间25～100 min,平均(65±12.5)min;术中出血量3～30 ml,平均(10±4.7)ml。术后5例恶心呕吐,1例腹泻,1例右肋缘下切口脂肪液化,经积极对症处理后患者均痊愈出院;术后住院3～6 d。电话或返院随访3～36个月,随访128例,脂肪餐前后B超对比检查,胆囊收缩面积>30%,胆囊收缩功能良好。3例复发,复发率2.4%。结论:合并常见慢性病患者行保胆取石(息肉)术具有患者创伤小、康复快、并发症少等优点,手术安全、有效,可提高术后患者生活质量。

Minimally invasive gallbladder preserving surgery for patients complicating chronic diseases

Objective:To discuss the safety and efficacy of laparoscopic and choledochoscopic gallbladder preserving surgery for the treatment of gallbladder stone(polypus)complicating chronic diseases.Methods:The clinical data of 175 patients suffering from gallbladder stone(polypus)complicating chronic diseases who underwent laparoscopic and choledochoscopic gallbladder preserving surgery between Feb.2009 and Feb.2012 were analyzed retrospectively.Results:Conversion to laparoscopic cholecystectomy was conducted in 3 patients with poor gallbladder function and 2 patients with uncontrolled intraoperative polypus fundus haemorrhage.The operation duration was 25-100 min,mean(65±12.5) min;The intraoperative blood loss was 3-30 ml,mean(10±4.7) ml;The postoperative complications include 5 cases of nausea and vomiting,1 case of diarrhea,and 1 case of lipid liquefaction,all of which were cured aftersymptomatic treatment.The hospital stay was 3-6 d.128 cases were followed up 3-36 m postoperatively,B-ultrasonography before and after fat load meal showed good gallbladder contraction function with a contraction area>30%.3 cases recurred after operation with a recurrence rate of 2.4%.Conclusions:Laparoscopic and choledochoscopic gallbladder preserving surgery for the treatment of gallbladder stone(polypus)complicating chronic diseases is a safe and effective procedure that has the advantage of less trauma,quicker recovery,fewer complications.