【摘要】 目的:探讨新式硬性胆道镜微创保留胆囊治疗胆囊管嵌顿结石的可行性。方法:2006年9月至2007年7月用胆道镜行微创保留胆囊治疗胆囊管嵌顿结石12例。喉罩全麻,迷你腹腔镜直视右肋缘下小切口抓取胆囊,胆囊底部小切口,用胆道镜行胆囊探查、胆囊管取石术。镜末端套上胆囊粘膜保护装置,推开胆囊管粘膜,暴露结石。对质地松软或质脆的结石直接用取石钳钳碎;坚硬的结石则用气压弹道连续冲击或间断冲击碎石,然后清除碎石。术中B超检查确认无残余结石后,用3-0肠线连续双重锁边缝合胆囊底部切口。结果:12例手术均获成功,其中3例行胆囊造瘘术,术后6周拔除造瘘管,经窦道再次行胆道镜检查无残余结石,近期疗效好。平均手术时间65m in,术中平均出血2m l,术后胃肠功能平均恢复时间16h,术后第1天可下地活动,平均住院4d。随访1~11个月恢复良好,胆囊结石无复发。结论:新式硬性胆道镜微创保留胆囊治疗胆囊管嵌顿结石安全、有效、彻底。更多还原

【Abstract】 Objective:To investigate the feasibility of mini compact nephroscope keeping gallbladder in situ in treatment of cystic duct in carceration calculi.Methods:Twelve patients undergoing minimally invasive surgery to unload cystic duct incarceration calculi and keep gallbladder in situ during Sep.2006 to Jul.2007 were retrospectively analyzed.All patients had laryngeal mask general anesthesia,whose cholecyst were grasped through a small cut below right costal margin under mini-celioscope.A tiny incision was made at the bottom of balstula.The mini-compact nephroscope was used to explore cholecyst and remove calculi from cystic duct,the end of the scope was sheathed with a protector for mucous membrane of gallbladder,through which the dictyo-basket or biopsy forceps could be imported among calculus and uctus cysticus wall,then membrane was pushed away and calculi were exposed.Biopsy forceps was used for curmbly or brittle calculi,and dictyo-basket was used to sheathe the calculi with dimeter over 0.5cm,suction was used for cases of smaller than 0.5cm,pneumatic lithotriptor was used for the hard calculi with continuoi impact or intermit impact,then pieces of calculus after clamping or impacting were removed with a suction cquipment and skill.After confirming of no retained calculus by ultrasound,the incision of the fundus of gallbladder was sewed up with 3-0 catgut ligature by continuous over-and-over whip suture.Results:12 cases of ductus cystic incarceration calculus were performed successfully,3 of them were made gallbladder stoma and the gallbladder stoma tubes were pulled out 6 weeks after surgery.No retained calculus were found through choledochoscope.Short-term outcome was good.The average operation time was 65 minutes,blood loss was 2ml,time of gastrointestinal function recovery was 16 hours and hospitalization was 4 days.All patients recovered well with no recurrence during the 1-11months follow-up.Conclusions:It is feasible,effective,and safe to perform minimally invasive surgery to cure cystic duct incarceration calculi and keep gallbladder in situ with new mini compact nephroscope.更多还原