郑明康+++高华国+++肖功亮

[摘要] 目的 探讨硬镜微创保胆取石术治疗小儿胆囊结石的安全性和有效性。 方法 回顾性分析珠海市妇幼保健院普外科2014年9～12月经硬镜微创保胆取石术治疗小儿胆囊结石9例的临床资料，并分析其手术疗效。 结果 9例患儿均成功行硬镜微创保胆取石术，无中转行胆囊切除术，成功率为100%；手术时间为25～70 min，平均（41.1±13.5）min；术中出血量3～10 mL，平均（5.3±2.4）mL；术后住院2～5 d，平均（3.2±0.9）d；术后疼痛按VRS评估，Ⅰ级8例，Ⅱ级1例；治疗期间未发生胆漏、术后出血、胆管损伤、胆源性胰腺炎及其他并发症。术后随访1～3个月，无胆囊结石复发，且术后1个月复查示胆囊壁厚度变薄及胆囊收缩率改善，但与术前比较，差异无统计学意义（P > 0.05）。 结论 硬镜微创保胆取石术治疗小儿胆囊结石是一种安全、有效的方法，操作简单、创伤小、恢复快，且能够保留胆囊功能，适合生长发育阶段的患儿。

[关键词] 硬质胆道镜；保胆手术；胆囊结石；儿童

[中图分类号] R575.6 [文献标识码] A [文章编号] 1673-7210（2015）05（b）-0107-04

Clinical analysis of mini-invasive gallbladder-preserving cholecystolithotomy with rigid choledochoscope in the treatment of 9 cases with gallstones

ZHENG Mingkang GAO Huaguo XIAO Gongliang

Department of General Surgery， Maternity and Child Health Hospital of Zhuhai City， Guangdong Province， Zhuhai 519001， China

[Abstract] Objective To investigate the safety and efficiency of mini-invasive gallbladder-preserving cholecystolithotomy with rigid choledochoscope in the treatment of gallstone in children. Methods Clinical data of 9 children with gallstones undergoing mini-invasive gallbladder-preserving cholecystolithotomy with rigid choledochoscope from September to December 2014 were retrospectively analyzed. The curative effects were analyzed. Results Mini-invasive gallbladder-preserving cholecystolithotomy with rigid choledochoscope was successfully performed in all the 9 patients without conversation to cholecystectomy， the success rate was 100%. Time of operation was 25-70 min， mean value of （41.1±13.5） min； intraoperative blood loss was 3-10 mL， mean value of （5.3±2.4） mL； postoperative hospital stay was 2-5 d， mean value of （3.2±0.9） d. Postoperative pain was assessed according to verbal rating scales （VRS）， and 8 cases were in grade Ⅰ， 1 case was in grade Ⅱ. There was no bile leakage， postoperative bleeding， biliary duct damage， biliary pancreatitis and other complications happened during therapy. The patients were followed up for 1 to 3 months after surgery， there was no gallstone recurrence. Thickness of gall bladder wall and contraction function of gallbladder had improved in 1 month after surgery， but comparing with before surgery， the difference was not statistically significant （P > 0.05）. Conclusion Mini-invasive gallbladder-preserving cholecystolithotomy with rigid choledochoscope is a safe and effective method in the treatment of gallstones in children. It is easy to use， has minimal trauma， and can retain function of gall bladder， and it is suitable for patients at the age of growth and development.endprint

[Key words] Rigid choledochoscope； Cholecystolithotomy； Gallsoe； Children

胆囊结石是一种成人常见病、多发病，小儿的发病率较低，但随着膳食结构与饮食习惯的改变，小儿胆囊结石发病率呈明显上升趋势。小儿胆囊结石致胆囊炎严重影响其身心健康，需要积极治疗。胆囊结石的治疗通常选择行胆囊切除术，但由于小儿的特殊性，不主张按成人的方式行胆囊切除术。已经有学者成功开展腹腔镜保胆手术治疗小儿胆囊结石[1]，但采取硬镜微创保胆取石术[2-3]方法治疗小儿胆囊结石鲜有报道。本研究应用硬镜微……