摘要
目的探讨经阴道软式内镜切除胆囊的可行性和安全性。方法 2010年5月,收治胆囊结石患者1例,行经阴道软式内镜胆囊切除术。患者取截石位,经阴道后穹窿开口失败后转前穹窿开口(2.5cm)入腹腔,同时置入多弯曲双孔道内镜(GIF-2TQ260M,Olympus)及一个5mm戳卡,建立气腹。镜下经戳卡送入1把抓钳,协助显露胆囊。经内镜活检通道送入IT刀,逆行游离胆囊。胆囊三角分离困难,遂经上腹部布置2个5mm戳卡,在内镜协助下分离和结扎胆囊管和胆囊动脉。经内镜双通道用2把异物钳抓住胆囊,与内镜一并自阴道取出。阴道切口用可吸收线缝合,腹部小切口不缝合。结果阴道入路耗时1h,切除胆囊耗时1h。术中无明显出血。患者术后无任何疼痛,术后第1天进食并下床活动,第2天出院。结论经阴道软式内镜胆囊切除术是安全可行的,但内外科医师间的配合还有待进一步提高。
Objective To study the feasibility and safety of cholecystectomy using transvaginal natural orifice translumenal endoscopic surgery （ NOTES ） techniques with a flexible endoscope. Methods A 43-year-old woman with symptomatic cholelithiasis was taken to the operating room for transvaginal choleeystectomy after giving informed consent. A colpotomy was made under direct vision. A muhi-bending flexible endoscope （ GIF-2TQ260M,Olympus ） was placed via the vaginal incision. Pneumoperitoneum to 15 mm Hg was obtained via a transvaginal trocar placed near the endoscope through the entrance. Two laparoscopic rigid-forceps were placed via two 5-mm trocars： one 5-mm trocar in the upper abdominal midline and one 5-mm trocar in the upper right quadrant. IT cautery through the endoscopic working channel was used to isolate the gallbladder. The cystic duct and artery were identified and clipped using laparoscopic clips from the abdominal port. The gallbladder was removed via the vaginal route. The vaginal incision was closed using an absorbable suture under direct vision. Results The procedures of colpotomy and cholecystectomy lasted lh respectively. The cholecystectomy was successfully performed without hemorrhage and spillage of bile. The patient was kept overnight for observation only as a precaution. She reported no pain and discharged 2 days after the procedure. Conclusions Flexible endoscopic transvaginal cholecystectomy,assisted by percutaneous rigid forceps, is feasbile and safty. Further cooperation of a physician and a surgeon will improve the success of pure NOTES cholecystectomy.
出处
《中华腔镜外科杂志（电子版）》
2010年第5期7-9,共3页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
中国人民解放军总医院技术创新项目的资助
关键词
经阴道途径
经自然腔道内镜手术
胆囊切除术
Transvaginal
Natural orifice transluminal endoscopic surgery
Cholecystectomy
