全腹腔镜下保胆取石一期缝合术402例报告

目的 探讨全腹腔镜下保胆取石一期缝合术(LRCL)的手术方法和适应证.方法 回顾性分析2002年3月至2011年11月开展LRCL 402例患者的临床资料.结果 施行LRCL 402例胆囊结石患者,成功373例(92.8%),中转腹腔镜胆囊切除术24例,出现并发症5例.无中转开腹,无继发胆总管结石,无死亡.手术时间30～160 min,平均约68 min.术后住院3～11 d.术后并发症率发生较低的缝合引流方法为:采用胆囊颈部切口和间断8字缝合,与非胆囊颈部切口和间断缝合、连续扣锁缝合相比具有统计学意义,P＜0.01.术后1、3、5 年的复发率为1.1%、2.4%和4.0%.结论 对于合适的病例,LRCL保持了胆囊的功能,具有安全、术后住院时间短、并发症少、康复快、结石复发率低等优点,具有良好的应用前景.

Complete laparoscopic cholelithotomy with primary suture for gallbladder stones:a report of 402 cases

Objective To summarize the experience in surgical operative precedures and indications of complete laparoscopic cholelithotomy with primary suture for gallbladder stones.Methods From March 2002 to November 2011,clinical data of 402 patients who had undergone complete laparoscopic cholelithotomy with primary suture for gallbladder stones were analyzed retrospectively.Results In 402 patients,373(92.8%) received laparoscopic cholelithotomy,24 converted to LC with no conversion to open operation,and 5 had postoperative complications.No perioperative death and secondary choledocholithiasis occurred.The operation time ranged from 30 to 160 minutes(average 68 minutes) with postoperative hospital stay of 3-11 days.Gallbladder neck incision or intermittent suture is a suture drainage with a low rate of postoperative complications(P<0.01).Postoperative recurrence rates at 1 year,3 years and 5 years were 1.1%,2.4% and 4.0% respectively.Conclusions For selective patients,complete laparoscopic cholelithotomy with primary suture preserved their function of gallbladder with several advantages including security,shorter postoperative hospital stay,less complications,quicker recovery,and lower recurrence rate.It is of great value to be applied in clinical practice.