完全腹腔镜保胆取石术65例临床分析

目的:探讨完全腹腔镜保胆取石术的手术方法及疗效。方法:回顾分析2009年12月至2011年12月为65例胆囊结石患者行完全腹腔镜保胆取石术的临床资料。结果:63例完成保胆取石术,35例采用3孔法,28例采用4孔法,5例行胆囊壶腹部切开取石术。手术时间60～210 min,平均119.5 min;术中出血量5～15 ml,平均10 ml;术后无出血、胆漏、急性胆管炎、胆总管继发结石及胰腺炎等并发症发生。住院4～7 d,平均5 d。术后超声检查提示61例胆囊结石全部取净,2例胆囊壁残留细小结石,结石取净率96.8%。术后随访0.5～2.5年,均无结石复发,术后胆囊收缩功能良好,无明显消化道症状。6例(9.5%)已随访2年以上,结石无复发。结论:完全腹腔镜保胆取石术充分发挥了腹腔镜与胆道镜的优势,效果更理想,手术安全可行。严格掌握手术适应证,规范手术操作,术后积极预防结石复发可取得良好疗效。

Clinical analysis of 65 cases of total laparoscopic gallbladder-preserving cholelithotomy

Objective:To evaluate operative method and treatment effect of total laparoscopic gallbladder-preserving cholelithotomy.Methods:From Dec.2009 to Dec.2011,65 patients with cholecystolithiasis were recruited for potential total laparoscopic gallbladder-preserving cholelithotomy.Clinical data of these patients were retrospectively analyzed.Results:Total laparoscopic gallbladder-preserving cholelithotomy was performed successfully in 63 patients.Two patients were treated with conventional laparoscopic cholecystectomy.35 patients underwent 3-port operation,and 4-port procedure was applied in 28 cases.Ampulla of gallbladder was dissected for removal of calculi in 5 cases.Mean operation time was 119.5 min(range,60-210 min),and mean intraoperative blood loss was 10 ml(range,5-15 ml).There were no significant postoperative complications,such as hemorrhage,bile leakage,acute cholecystitis,secondary choledocholith or pancreatitis.Mean postoperative hospital stay was 5 d(range,4-7 d).Postoperative ultrasound examination showed that gallstones were removed completely in 61 patients(96.8%).Two patients(3.2%) had residual small calculi in the gallbladder wall.No recurrence of gallstone was identified during follow-up(6-30 months).All gallbladders had good contractile function.No obvious digestive tract symptoms were observed.6 patients(9.5%) were followed up for above 2 years,and no recurrence of calculi was found.Conclusions:Total laparoscopic gallbladder-preserving cholelithotomy is safe,feasible and associated with good short-term results under strict indications.This procedure makes full use of advantages of laparoscopy and choledochoscopy.The satisfactory therapeutic effect is guaranteed by standard manipulation and positive prevention of calculi recurrence after operation.