摘要
目的 :使胆石症病人最大机会选择内镜手术治疗这种微创治疗 ,改良几种内镜操作方法及手术器械 ,几种内镜配合作用 ,有效拓宽手术适应症。方法 :经皮胆镜碎石清除术 (PCCL)手术方法、器械改良 ;腹腔镜胆囊切除术 (LC) ;经腹腔镜纤维胆道镜胆总管探查、取石、T管引流术 (LCRTD)。胆系结石术后结石残留经引流窦道纤维胆道镜取石术 (POC)。结果 :病人合计 40 4例。PCCL组 198例 ,均为胆囊结石 ,手术成功 194例 (98.0 % ) ,平均住院 17.3d ;LC组 10 3例 ,均为胆囊结石 ,合并息肉 6例 ,手术成功 10 2例 (99.0 % ) ,平均住院 4.8d ,LCRTD组 ,胆总管结石 47例 ,合并胆囊结石 2 6例 ,合并肝内胆管结石 11例。手术成功 46例 (97.9% )。平均住院 2 9.3d ;POC组 5 6例 ,1次取净 31例 (5 5 .4% ) ,2～ 3次取净 17例 (30 .4% ) ,3次以上 7例 (16 .1% )。无需住院。各组均无死亡病例。结论 :结合几种不同内镜治疗胆石症特点综合应用 ,完成了去除结石保留有功能胆囊 ;去除有病变胆囊 ;去除胆总管、肝内胆管结石及胆道术后残留结石 ,以微创的内镜手术方法替代传统开腹手术方法。
Objective: In order to select the minimally invasive endoscopic surgery for the patients with cholecystolithiasis, we modify 3 endoscopic surgery methods and operative instruments. Combining several endoscopes, we try to develop endoscopic surgical indications. Methods: (1) Modification of percutaneous endoscopic cholelithotripsy (PCCL) and partial instruments; (2) Laparoscopic cholecystectomy (LC). (3) Laparoscopic choledochotomy removing stones and 'T' tube drainage (LCRTD). (4) Postoperative cholelith endoscopy via fistula (POC). Results: The success rates of the endoscopic surgery in PCCL group, LC group and LCRTD group were 98% (194/198), 99% (102/103) and 97.9% (46/47) respectively. In POC group of 56 cases, the stones in 31 cases (55.4%) are removed completely once; 17 cases (30.4%) two to three times; 7 cases (16.1%) more than three times. Conclusions: Joint endoscopic surgery has many advantages and can replace the conventional transabdominal approach.
出处
《中国内镜杂志》
CSCD
2001年第4期24-25,27,共3页
China Journal of Endoscopy
基金
铁道部医学科研资金资助项目 ( 970 2 2 )
