腹腔镜胆囊部分切除术保胆治疗胆囊畸形 （附36例报告）

Laparoscopic partial cholecystectomy for gallbladder preservation of cholecyst deformity (a reports of 36 cases)

摘要:

目的 探讨腹腔镜胆囊部分切除术保胆治疗胆囊畸形的可行性。方法 2008年4月~2012年4月对36例胆囊畸形的患者行腹腔镜联合胆道镜胆囊部分切除术。将胆囊畸形分为胆囊萎缩和折叠畸形两种，病变部位皆位于胆囊的远端，慢性炎症明显，且≤1/2。其中胆囊萎缩16例，呈葫芦状；占胆囊1/3者、1/4者各8例。折叠畸形20例，畸形与体部成角≥90°；占胆囊1/2者9例，1/3者7例，1/4为4例。保留的胆囊功能基本正常：胆囊管通畅，胆囊壁≤3 mm，炎症不重，胆囊收缩试验≥30%。本组合并胆囊结石33例，占91.7%，18例是黑色胆色素及胆色素为主的混合性结石，占54.5%。15例是胆固醇及胆固醇为主的混合性结石，占45.5%。切除有病变的胆囊后，胆道镜检查取净结石，4-0可吸收线连续两层缝合胆囊。结果 36例手术均获成功，手术时间（108±18）min；排气时间分别是（25.9±1.8）h；胆漏2例，每日5~10 mL，术后4、6 d拔除引流管，术后7 d痊愈出院。所有患者均获随访，随访时间3~46个月，患者术前临床症状消失，无胆囊切除术后腹痛、脂肪泻等并发症的临床表现；术后胆囊收缩试验（53%±10%），较术前（39%±7%）明显提高（t=-11.81；P <0.001）。 结论 腹腔镜联合胆道镜胆囊部分切除术在掌握适应证的情况下是治疗胆囊畸形的有效方法，对保护胆囊及胆囊功能具有重要的意义，是一种新的保胆术式和方法。

Abstract:

【Objective】 To study the feasibility of laparoscopic and choledochoscopic treating gallbladder deformity in partial cholecystectomy. 【Methods】 From April 2008 to April 2012, 36 cases of gallbladder deformity were treated with partial cholecystectomy combined with laparoscopic and choledochoscopic. All the patients were divided into atrophy group (n=16) and fold group (n=20). The deformity at the far-end of gallbladder, ≤1/2 of gallbladder and had evidently chronic inflammation. The atrophy is a gourd -shaped form (1/3=8, 1/4=8); fold deformity in the angulation of≥90 degree (1/2=9,1/3=7,1/4=4). The function of the remain gallbladder was basically normal: ductus cysticus being unobstructed；the thickness of the gallbladder wall≤3 mm; contractibility of gallbladder test≥30%. The 33 cases had cholelithiasis (91.7%),18 cases had dark bile pigment gallstone (54.5%),15 cases had cholesterol gallstone (45.5%). The deformity was cut off, all calculus taken out with choledochoscopy, 4-0 absorbable threadwas used to suture the gallbladder with two consecutive layers. 【Results】 All 36 cases were performed successfully: operation time: (108±18) min； exhaust time: (25.9±1.8) h; 2 cases had bile leakage every day 5~10 ml, the drain had been extubated in 4~6day；and the patients were discharged 7 days after the operation. All patients have been followed up: follow-up time: 3~46 months；patient’s preoperative clinical symptoms disappeared, and the test of contractibility of gallbladder of postoperative group was better improved than preoperative group (51%±10%) vs (39%±7%), t=-11.81; P <0.001. 【Conclusion】 Partial cholecystectomy combined with laparoscopic and choledochoscopic is an effective method in treating gallbladder deformity on the condition of well known indication, and it has a great significance in protecting the gallbladder and its function.