胆囊结石合并肝癌、肝硬化患者腹腔镜保胆取石术一例报告

目的探讨针对胆囊结石合并肝硬化、肝癌患者施行腹腔镜保胆取石术的适应证和手术方法。方法 1例胆囊结石合并肝硬化、肝癌患者在全麻下采用腹腔镜胆囊切除术(LC)的标准四戳孔,借助胆道镜、取石网处理胆囊结石,胆囊壁切口用3-0可吸收缝针线"8"字扣锁缝合,取出的胆囊结石装入标本袋从脐部穿刺孔取出。Winslow孔附近常规放置1根多孔腹腔引流管观察渗漏情况。结果施行保胆取石术1例成功。术后第1天腹腔引流管引流出淡红色渗出液120 ml,随后逐日减少,颜色逐渐变为淡黄色,术后7 d拔除腹腔引流管。手术历时(穿刺Trocar到取出标本袋)130 min,术后10 d出院。无任何手术并发症发生。患者手术后次日即能正常进食。结论胆囊结石合并肝硬化、肝癌的患者,如果胆囊炎反复发作,严重影响生活,并且肝硬化、肝癌经治疗处于稳定期,无明显腹水,凝血功能尚可,胆囊存在收缩功能,就能够比较安全地施行腹腔镜保胆取石术。术后可显著改善患者生活质量。

Preservation of gallbladder and removal of calculus by laparoscopy combined with choledochoscopy for one patient taking diseases of cholecystlithiasis, liver cirrhosis and primary hepatic carcinoma

Objective The purpose of this paper was to discuss the indications and methods of treating the cholecystlithiasis simultaneously combined with liver cirrhosis and primary hepatic carcinoma by laparoscopy and choledochoscopy for preservation of cholecyst.Methods A patient simultaneously taking diseases of cholecystlithiasis,liver cirrhosis and primary hepatic carcinoma received cholelithotomy with the gallbladder being preserved in our hospital by laparoscopy and choledochoscopy.The incision of the gallbladd...