目的 探讨腹腔镜-胆道镜双镜联合保胆取石治疗胆囊结石的临床应用价值。方法 回顾分析我院采用全腹腔镜下双镜联合保胆取石术治疗62例胆囊结石患者的临床资料。结果 本组手术均顺利完成。术后无出血及胆漏，2例出现胆囊积血。术后随访3-26个月，2例患者出现胆囊结石复发，结石复发率3.2%。结论 全腹腔镜下双镜联合保胆取石术技术可行，手术安全，效果可靠，是治疗胆囊结石的一种有效手段。
Objective To discuss and analyze the application of gallbladder-preserving cholelithotomy by a combination of laparoscopy and choledochoscopy for cholecystolithiasis.Methods 62 patients with cholecystolithiasis were recruited for Gallbladder-preserving cholelithotomy.Clinical data of these patients were retrospectively analyzed.Results All patients underwent cholelithotomy successfully with this approach.There was no complication of hemorrhage and bile leakage.2 patients with gallbladder hematocele was observed.2 patients with recurrence of gallstone were identified during a follow-up of 3 to 26 months.Conclusions Gallbladder-preserving cholelithotomy by a combination of laparoscopy and choledochoscopy is a safe,feasible and effective approach for cholecystolithiasis.
[1] 叶忻,王保钢,项晓宇,等.上海江湾地区成年人胆囊结石发病情况调查[J].肝胆胰外科杂志,2003,15(1):28-30.
[2] 刘京山,李晋忠,赵期康等.纤维胆道镜下胆囊切开取石保胆治疗胆囊结石612例随访结果分析[J].中华外科杂志,2009,47(4):279-281.
[3] 刘衍民,文辉清.目前保留胆囊手术的几个问题[J].中华外科杂志,2008,46(10):721-723.
[4] 王坚,王吴陆,李可为.胆囊结石治疗策略的争论与选择:胆囊切除还是保胆取石[J].中国实用外科杂志,2011,31(1):44-46.
[5] 张宝善.胆道外科的治疗进展一内窥镜技术在胆道外科中的应用[J].中国医师进修杂志,2006,29(4B):1-3.
[6] 荣万水,刘京山,雷福明,等.胆石症患者不同术式后生存质量调查[J].中国内镜杂志,2010,16(7):685-688.
[7] 中国医师协会内镜医师分会微创保胆委员会.内镜微创保胆手术指南(2011版)[J].中国内镜杂志,2012,18(4):48-51.
[8] 蒋兆彦,韩天权,张圣道.胆囊结石发病机制的当前认识[J].腹部外科,2010,23(5):264-265.
[9] Cui W,Jiang ZY,Cai Q,et al.Decreased NPC1L1 expression in the liver from Chinese female gallstone patients [J].Lipids Health Dis,2010 Feb 8;9:17
[10] Jiang ZY,Jiang CY,Wang L,et al.Increased NPC1L1 and ACAT2 expression in the jejunal mucosa from Chinese gallstone patients[J].Biochem Biophys Res Commun,2009,30 (1):49-54.
[11] Zanlungo S,Rigotti A,Nerv IF.Hepatic cholesterol transport from plasma into bile:implications for gallstone disease[J].Curr Opin lipidol,2004,15(3):279-286.
[12] Sun BJ,Cu INQ,Li DH,et al.Effects of choleretics on bile compositions drained from patients with pigment gallstone [J].Chin J Integr Med,2006,12(2):101-106.
[13] 李栋,胆囊结石外科手术治疗的争议[J].医学综述,2012,18(6):901-904.
[14] 韩天权,张圣道.保胆取石术后胆石的复发及预防[J].中华肝胆外科杂志,2009,15(1):4-5.
