全腹腔镜下保胆取石、取息肉和即时缝合术的应用

发布时间：2018-05-31 18:20

本文选题：腹腔镜 + 保胆治疗　；参考：《四川医学》2008年12期

【摘要】：目的探讨全腹腔镜下保胆取石、取息肉和即时缝合术的手术方法和适应证。方法132例患者在全麻下采用腹腔镜胆囊切除术的标准四戳孔,借助胆管镜、取石网、电热圈套器和斑马导丝处理胆囊结石和胆囊息肉,胆囊壁切口用2-0或3-0可吸收缝线连续扣锁缝合或间断8字缝合,取出的胆囊结石和胆囊息肉装入标本袋从剑突下孔或脐部孔取出。Winslow孔附近常规放置两根多孔腹腔引流管观察渗漏情况。结果施行保胆取石即时缝合术117例和保胆取息肉即时缝合术15例,成功114例,中转为腹腔镜胆囊切除术13例,胆漏2例,残余结石1例,再生结石1例,胆管出血1例。腹腔引流管引流出渗出液20~300ml/d,术后2~7d拔除。无中转开腹,无死亡。手术历时30~160min,平均约70min。术后住院3~10d。结论只要选择合适的患者,确切的胆管镜检查和治疗,可靠的缝合胆囊壁切口,施行全腹腔镜下保胆取石、取息肉和即时缝合术可行、有效、安全。此方法可以保留有功能的胆囊。
[Abstract]:Objective to investigate the operative methods and indications of laparoscopic cholecystectomy, polyp extraction and immediate suture. Methods 132 patients with cholecystolithiasis and polyp of gallbladder were treated by laparoscopic cholecystectomy under general anesthesia, with the aid of choledochoscope, lithograph, electrothermal trap and zebra guide wire. The cholecystectomy was sutured with 2-0 or 3-0 absorbable sutures or interrupted 8-word suture. The gallstone and polyp of gallbladder were packed into specimen bags and two porous celiac drainage tubes were routinely placed in the vicinity of the foramen below the process or the umbilical foramen to observe the leakage. Results 117 cases of cholecystolithiasis and 15 cases of polyps were sutured immediately, 114 cases were successful, 13 cases were converted to laparoscopic cholecystectomy, 2 cases were bile leakage, 1 case was residual stone, 1 case was regenerative stone, 1 case was bile duct hemorrhage. Peritoneal drainage exudate 20 ~ 300 ml / d was removed 2 ~ 7 days after operation. No transitory operation, no death. The operation lasted 30 minutes, 160 mins, with an average of 70 mins. Postoperative hospitalization was 3 minutes and 10 days. Conclusion it is feasible, effective and safe to select the right patient, to examine and treat the choledochoscopy, to suture the cholecystectomy, to carry out total laparoscopic cholecystolithiasis removal, polyp extraction and immediate suture. This method can preserve functional gallbladder.
【作者单位】：成都市第二人民医院普外科;
【分类号】：R657.42

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