Experience in treatment of 326 patients with gallstones
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摘要: 目的探讨胆囊结石临床分期及规范化治疗模式的可行性。方法对2012年1月-2013年12月期间在新安县人民医院治疗的326例胆囊结石患者,依据其临床资料,按结石对胆囊的病理侵害程度进行术前分期(ⅠⅣ期),决定相应的治疗方式,观察临床效果。结果本组326例患者中,Ⅰ期患者57例,小切口胆道镜取石保胆术53例,其中中转胆囊造瘘术3例,1年后发生胆囊结石复发1例;腹腔镜胆囊切除术4例。Ⅱ期患者152例,腹腔镜胆囊切除术122例,其中中转开腹胆囊切除术2例,发生胆漏2例,无胆管损伤严重并发症;开腹胆囊切除术30例,发生切口脂肪液化2例,无胆漏、胆管损伤发生。Ⅲ期患者87例,开腹胆囊切除术50例,发生切口脂肪液化3例,无胆漏、胆管损伤发生;开腹胆道镜辅助胆囊造瘘术37例,发生切口脂肪液化7例,10例术后3个月造影显示胆囊管不通,或胆囊管开口异常而行开腹胆囊切除术。Ⅳ期患者30例,行胆囊切除术+胆总管切开取石术30例,发生切口脂肪液化2例,无胆漏、胆管损伤。患者均痊愈出院,无死亡病例。总的不良事件发生率为6.75%。结论对胆囊结石患者实行规范化治疗,是保证胆囊结石患者治疗效果,...Abstract: Objective To investigate the feasibility of clinical staging and standardization of therapy for patients with gallstones.Methods The clinical data of 326 cases of gallstones treated in our hospital from January 2012 to December 2013 were collected.Appropriate surgical procedures were selected based on preoperative staging(stags Ⅰ-Ⅳ) that was conducted according to the degree of pathological damage in the gallbladder.Clinical efficacy was observed for assessment.Results Among 57 patients categorized as stage I,53 cases received choledochoscopy by small incision for preservation of the gallbladder,including 3 cases converted to cholecystostomy and 1 case of recurrent gallstones one year later; laparoscopic cholecystectomy was performed in the remaining 4 cases.A total of 152 patients were categorized as stageⅡ: 122 cases received laparoscopic cholecystectomy,of which 2 cases were converted to open cholecystectomy,2 cases developed bile leakage,and none suffered serious complication of bile duct injury; open cholecystectomy was performed in the other 30 cases in category II,2of which had fat liquefaction at the incision,but complications of bile leakage and bile duct injury were not observed.There were 87 patients with stage Ⅲ disease: among 50 cases who received open cholecystectomy,3 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed; in the remaining 37 cases who received open choledochoscope-assisted cholecystostomy,7 cases developed fat liquefaction at the incision,and 10 cases eventually underwent open cholecystectomy three months after the operation due to cystic duct closure and opening abnormality detected by angiography.Thirty patients with stage IV disease underwent cholecystectomy and choledocholithotomy,of which 2 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed.All326 patients were cured without mortality.The incidence of adverse events was 6.75%.Conclusion The standardization of therapy for patients with gallstones is an effective approach to ensure the clinical efficacy and to avoid or reduce postoperative complications.It should be promoted in clinical settings.
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Key words:
- cholecytolithiasis /
- digestive system surgical procedures
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