胆道镜下定向微爆破技术治疗胆囊巨大、嵌顿结石在保胆取石术中的临床应用

目的:探讨胆道镜下定向微爆破碎石技术治疗胆囊巨大、嵌顿结石在保胆取石术中的安全性及可行性。方法:采用体内微爆破碎石仪在纤维胆道镜直视下定向碎石治疗93例胆囊巨大、嵌顿结石患者。结果:93例患者碎石2～11次,平均(3.67±0.52)次1,例术后发生急性胆囊炎,急诊行经皮经肝胆囊穿刺引流;1例胆囊壁水肿置管引流,6周后经胆道镜探查胆囊粘膜恢复正常后拔除。91例用4-0可吸收线一次性缝合胆囊壁,所有患者术后均无胆囊穿孔、胆漏、胆囊出血等并发症发生,无一例中转胆囊切除术。结论:在胆道镜直视下应用体内微爆破定向碎石技术治疗胆囊巨大、嵌顿结石安全、有效,为保胆手术的成功提供了理想的手术方法。

Application of choledochoscope guided lithoclasty for huge and incarcerated cholecystolithiasis in laparoscopic gallbladder-preserving cholelithotomy

Objective:To investigate the safety and feasibility of choledochoscope guided lithoclasty for huge and incarcerated cholecystolithiasis in gallbladder-preserving cholelithotomy. Methods:Ninety-three patients with huge and incarcerated cholecystolithiasis underwent the treatment and clinical data was analyzed retrospectively. Results:All the operations were successfully performed without conversion to cholecystectomy.All patients underwent 2-11 times of lithoclasty,with the average of(3.67±0.52).The gallbladder wall of 91 cases was sutured with 4-0 absorbable thread.Acute cholecystitis occurred in 1 case after operation,which was performed emergent percutaneous transhepatic gallbladder puncture and drainage.1 case underwent drainage because of gallbladder wall edema,and the drainage tube was removed 6 weeks later,when the gallbladder mucosa was normal under choledochoscopy.No other postoperative complications occurred such as gallbladder perforation,bile leakage or hemorrhage. Conclusions:Lithoclasty under direct view of choledochoscope is safe and effective for huge and incarcerated cholecystolithiasis,and it is an ideal treatment for gallbladder-preserving cholelithotomy.