Bulldog夹在三孔法腹腔镜保胆取石术中的应用分析

目的 探讨Bulldog夹在三孔法腹腔镜保胆石取石术中的应用价值。方法 回顾2014年7月~2016年 8月华中科技大学同济医学院附属中西医结合医院接受三孔法腹腔镜保胆取石术病例36例，术中均于胆道镜取石操作前采用Bulldog夹临时阻断胆囊管，观察并记录结石标本的性状、分布和数量，检测术后肝功能及炎症反应情况，并对手术前后胆囊声像学表现进行评估。结果 所有36例患者均顺利完成手术操作，其中小胆石者（<0.3 cm）占22.22%，胆色素结石者占52.78%，胆道镜证实胆囊管结石者为13.89%。术后第3天，观察组平均TBIL、DBIL、ALP均处于正常范围内，PCT及CRP水平亦未超过正常值上限；与术前相比，术后2月彩超复查胆囊壁厚度（2.37±1.42 mm vs 2.25±0.72 mm），无统计学差异(P>0.05)，且未发现胆囊腔内残石及胆管扩张病例。结论 Bulldog钳可以作为安全有效的胆囊管暂时阻断器械应用于GPLC术中，在提高胆囊管结石清除率的同时，有效防止胆石溢入胆总管，且不会增加术后胆囊炎、胆囊动脉损伤风险。

Application of Bulldog Clip in Three-hole Laparoscopic Cholelithiasis Extraction

Abstract:Objective To explore the application value of Bulldog clamp in three-hole laparoscopic gallbladder lithotripsy.Methods A retrospective review of 36 cases of laparoscopic gallbladder lithotripsy with three-hole laparoscopic surgery was performed between July 2014 and August 2016 in an integrated Chinese and western medicine hospital of Tongji Medical College of Huazhong University of Science and Technology.During the operation,Bulldog clips were temporarily used to block the stones before choledochoscopy.The cystic ducts were used to observe and record the traits,distribution,and quantity of the specimens.The postoperative liver function and inflammatory reactions were examined.The gallbladder sonography before and after surgery was evaluated.Results All 36 patients completed the operation successfully, of which 22.22% were small cholelithiasis(<0.3 cm),52.78% were biliary pigment stones, and 13.89% were cystic duct calculi diagnosed by choledochoscopy.Third days after operation,the observation group average TBIL,DBIL and ALP were in the normal range,PCT and CRP levels did not exceed the upper limit of the normal value;compared with the preoperative,postoperative 2 months of Doppler ultrasound the thickness of gallbladder wall（2.37±1.42mm vs 2.25±0.72mm）,no significant difference(P>0.05),and did not find the gallbladder and bile duct residual stone cases.Conclusion Bulldog forceps can be used as a safe and effective temporary blocking device for cystic duct in GPLC operation,while improving the clearance rate of cystic duct stone and effectively preventing gallstone invasion into common bile duct,and does not increase the risk of cholecystitis and gallbladder artery injury after cholecystectomy.