胆囊切开取石术治疗胆囊结石的价值

目的　探讨胆囊切开取石术对胆囊结石症的远期疗效及适应证。 方法　对５０ 例轻症单纯性胆囊结石病人，经口服胆囊造影确定胆囊具有一定收缩功能后接受该手术。手术于右上腹行小切口，取出胆囊结石。胆道镜检查确认没有残留结石。在胆囊粘膜下层作不穿越粘膜层的Ⅰ期缝合，不置胆囊造瘘管。术后早期使用利胆剂，早期进食。 结果　５０ 例病人均痊愈出院，术后平均住院３５ 天。随访５ 年，４２ 例（４２／５０ ，８４ ％ ） 治愈，３０ 例（３０／５０ ，６０ ％ ） 胆囊收缩功能良好。共有８ 例复发胆囊结石，葫芦状胆囊、化脓性胆囊炎、萎缩性胆囊炎和胆囊管过长各１ 例，９ 例胆囊胆固醇沉积症复发４ 例。８ 例胆囊收缩功能３０ ％ ～５０ ％ 者５ 例复发结石。 结论　胆囊切开取石术适于轻症胆囊结石、胆囊无畸形和胆囊收缩功能良好者，效果较好，但必须严格掌握适应证，并注意恰当操作。

The evaluation of cholecystolithotomy for gall stones

Objective To explore the long term result of cholecystolithotomy for gall stones and its clinical indications.Methods Before operation,the gall bladder was proved as functional in all 50 gall stone patients by oral cholecystography.The stones were regarded as asymptomatic or causing mild symptoms.Ultrasound examination was performed to determine the number and size of gall stones. Cholecystolithotomy was successfully performed in all 50 patients. The complete removal of the stones was proved by choledochoscope and the incision on the gallbladder was closed by sutures which did not cut through the mucus membrana.No peritoneal drainage was needed.Results The postoperative course was uneventful in all cases.The average postoperative inhospital stay was 3 5 days. All cases were followed for up to 5 years. 42 of 50 (84%) cases were cured with good gallbladder function.Stone recurred in 8 cases including atrophic gallbladder,a preoperative history of suppurative cholecystitis, Hour glass gallbladder,and tortuous gall duct in one each.Stone recurrence in 3 years was found in 4 out of 9 cases with cholesterosis,and in 5 out of 8 in which preoperative function of contraction was less than 50% evaluated by oral cholecystography. Conclusion Cholecystolithotomy is safe and effective in carefully selected patients.