• 四川省達(dá)州市中心醫(yī)院肝膽外科中心(達(dá)州 635000);

目的  介紹內(nèi)鏡保膽取石術(shù)的臨床研究現(xiàn)狀。
方法  復(fù)習(xí)和總結(jié)了近年來的相關(guān)文獻(xiàn),對(duì)保膽的依據(jù)、保膽取石術(shù)的優(yōu)勢(shì)及其適應(yīng)證和禁忌證、手術(shù)方法 、當(dāng)前存在的爭(zhēng)議等問題進(jìn)行綜述。
結(jié)果  膽囊切除術(shù)后并發(fā)癥為內(nèi)鏡保膽取石術(shù)提供了客觀依據(jù),內(nèi)鏡技術(shù)上的進(jìn)步為保膽提供了可能。內(nèi)鏡保膽取石術(shù)的爭(zhēng)議主要是適應(yīng)證的選擇和手術(shù)操作,不恰當(dāng)?shù)剡x擇病例,盲目追求保膽取石將使膽囊結(jié)石的治療事與愿違。
結(jié)論  內(nèi)鏡保膽取石術(shù)能夠取盡結(jié)石,保留膽囊功能,但術(shù)后結(jié)石復(fù)發(fā)有待更進(jìn)一步的研究和長(zhǎng)期隨訪。

引用本文: 王旭,王翔翔,唐彤,孫建明. 內(nèi)鏡保膽取石術(shù)臨床研究現(xiàn)狀. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(9): 773-776. doi: 復(fù)制

1. 吳階平, 裘法祖主編. 黃家駟外科學(xué) [M]. 第6版. 北京: 人民衛(wèi)生出版社, 2000: 1290-1291.
2. 冉瑞圖. 關(guān)于膽囊切除術(shù)的幾點(diǎn)意見 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 81-82.
3. Stathopoulos P, Zundt B, Spelsberg FW, et al. Relation of gallbladder function and Helicobacter pylori infection to gastric mucosa inflammation in patients with symptomatic cholecystolithiasis [J]. Digestion, 2006; 73(2-3): 69-74.
4. Moorehead RJ, Mills JO, Wilson HK, et al. Cholecystectomy and the development of colorectal neoplasia: a prospective study [J]. Ann R Coll Surg Engl, 1989; 71(1): 37-39.
5. Vernick LJ, Kuller LH, Lohsoonthorn P, et al. Relationship between cholecystectomy and ascending colon cancer [J].Cancer, 1980; 45(2): 392-395.
6. Morvay K, Szentléleki K, Trk G, et al. Effect of change of fecal bile acid excretion achieved by operative procedures on 1, 2-dimethylhydrazine-induced colon cancer in rats [J]. Dis Colon Rectum, 1989; 32(10): 860-863.
7. Bandettini L, Filipponi F, Romagnoli P. Increase of the mitotic index of colonic mucosa after cholecystectomy [J]. Cancer, 1986; 58(3): 685-687.
8. 孫登群, 汪國(guó)營(yíng), 孟翔凌, 等. 膽囊結(jié)石、膽囊切除術(shù)與大腸癌關(guān)系的臨床研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 208-209.
9. 李樹吉, 張秀云. 醫(yī)源性膽管損傷的預(yù)防與治療(國(guó)內(nèi)文獻(xiàn)綜述) [J]. 中國(guó)普通外科雜志, 2005; 14(8): 608-610.
10. Lum YW, House MG, Hayanga AJ, et al. Postcholecystectomy syndrome in the laparoscopic era [J]. J Laparoendosc Adv Surg Tech A, 2006; 16(5): 482-485.
11. Madácsy L, Fejes R, Kurucsai G, et al. Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction: effect of papillotomy [J].World J Gastroenterol, 2006; 12(42): 6850-6856.
12. 冉瑞圖. 發(fā)展中國(guó)特色的膽道外科 [J]. 中華肝膽外科雜志, 2006; 6(3): 163-165.
13. 榮萬水. 內(nèi)鏡保膽取石術(shù)與腹腔鏡膽囊切除術(shù)對(duì)患者生存質(zhì)量的影響 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(8): 23-25.
14. Grundy SM. Cholesterol gallstones: a fellow traveler with metabolic syndrome? [J]. Am J Clin Nutr, 2004; 80(1): 1-2.
15. Jiang ZY, Parini P, Eggertsen G, et al. Increased expression of LXR alpha, ABCG5, ABCG8, and SR-BI in the liver from normolipidemic, nonobese Chinese gallstone patients [J]. J Lipid Res, 2008; 49(2): 464-472.
16. Wang Y, Jiang ZY, Fei J, et al. ATP binding cassette G8 T400K polymorphism may affect the risk of gallstone disease among Chinese males [J]. Clin Chim Acta, 2007; 384(1-2): 80-85.
17. Kuo KK, Shin SJ, Chen ZC, et al. Significant association of ABCG5 604Q and ABCG8 D19H polymorphisms with gallstone disease [J]. Br J Surg, 2008; 95(8): 1005-1011.
18. 孔凡民, 隋春陽, 李航宇, 等. 膽囊膽固醇結(jié)石與肝細(xì)胞膽管膜上轉(zhuǎn)運(yùn)子BSEP、MRP2和MDR3關(guān)系的研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(3): 314-316..
19. Ure BM, De Jong MM, Bax KN. Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystolithiasis: a preliminary report [J]. Pediatr Surg Int, 2001; 17(5-6): 396-398.
20. 楊五計(jì), 胡安國(guó), 李志偉, 等. 經(jīng)皮膽鏡碎石清除術(shù)的術(shù)式及適應(yīng)證 [J]. 中華普通外科雜志, 2001; 16(6): 328-330.
21. Kellett MJ, Wickham JE, Russel RC. Percutaneous cholecystolithotomy [J]. Br Med J (Clin Res Ed), 1988; 296 (6620): 453-455.
22. 錢志平, 肖蔭祺, 李為民, 等. 經(jīng)皮膽囊碎石術(shù)的臨床應(yīng)用 [J]. 中華外科雜志, 1991; 29(10): 619-622.
23. 張冰, 荀祖武, 方榮興, 等. 經(jīng)皮膽鏡膽囊碎石清除術(shù): 附421報(bào)告 [J]. 中華外科雜志, 1991; 29(6): 350-351.
24. 蕭蔭祺, 錢志平, 許紅兵, 等. 經(jīng)皮膽囊碎石術(shù)的近期隨訪結(jié)果  [J]. 普外臨床, 1993; 8(4): 205-207.
25. 張寶善. 關(guān)于膽囊結(jié)石治療的爭(zhēng)論-與Langenbuch理論商榷 [J]. 中國(guó)醫(yī)刊, 2007; 42(5): 2-5.
26. 榮萬水. 微創(chuàng)膽囊切開取石術(shù)的臨床評(píng)價(jià) [J]. 中國(guó)內(nèi)鏡雜志, 2002; 8(12): 21-23.
27. 徐立友, 宋釗, 付廷海, 等. 623例內(nèi)鏡保膽取石術(shù) [J].中華消化外科雜志, 2007; 6(6): 459-461.
28. 陳培, 王炳生, 何連齊, 等. 上海地區(qū)膽囊結(jié)石復(fù)發(fā)的多因素分析 [J]. 中華普通外科雜志, 1998; 13(3): 134-136.
29. 鄒一平, 蕭蔭祺. 保膽取石術(shù)有關(guān)問題的探討 [J]. 中華肝膽外科雜志, 2009; 15(1): 1-3.
30. 劉衍民, 文輝清. 目前保留膽囊手術(shù)的幾個(gè)問題 [J]. 中華外科雜志, 2008; 4(10): 721-723.
31. 程國(guó)華, 隋晉平, 陸明. 經(jīng)皮膽鏡膽囊碎石取石術(shù)(附684例報(bào)告) [J]. 中國(guó)普通外科雜志, 1994; 3(1): 15-17.
  1. 1. 吳階平, 裘法祖主編. 黃家駟外科學(xué) [M]. 第6版. 北京: 人民衛(wèi)生出版社, 2000: 1290-1291.
  2. 2. 冉瑞圖. 關(guān)于膽囊切除術(shù)的幾點(diǎn)意見 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 81-82.
  3. 3. Stathopoulos P, Zundt B, Spelsberg FW, et al. Relation of gallbladder function and Helicobacter pylori infection to gastric mucosa inflammation in patients with symptomatic cholecystolithiasis [J]. Digestion, 2006; 73(2-3): 69-74.
  4. 4. Moorehead RJ, Mills JO, Wilson HK, et al. Cholecystectomy and the development of colorectal neoplasia: a prospective study [J]. Ann R Coll Surg Engl, 1989; 71(1): 37-39.
  5. 5. Vernick LJ, Kuller LH, Lohsoonthorn P, et al. Relationship between cholecystectomy and ascending colon cancer [J].Cancer, 1980; 45(2): 392-395.
  6. 6. Morvay K, Szentléleki K, Trk G, et al. Effect of change of fecal bile acid excretion achieved by operative procedures on 1, 2-dimethylhydrazine-induced colon cancer in rats [J]. Dis Colon Rectum, 1989; 32(10): 860-863.
  7. 7. Bandettini L, Filipponi F, Romagnoli P. Increase of the mitotic index of colonic mucosa after cholecystectomy [J]. Cancer, 1986; 58(3): 685-687.
  8. 8. 孫登群, 汪國(guó)營(yíng), 孟翔凌, 等. 膽囊結(jié)石、膽囊切除術(shù)與大腸癌關(guān)系的臨床研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 208-209.
  9. 9. 李樹吉, 張秀云. 醫(yī)源性膽管損傷的預(yù)防與治療(國(guó)內(nèi)文獻(xiàn)綜述) [J]. 中國(guó)普通外科雜志, 2005; 14(8): 608-610.
  10. 10. Lum YW, House MG, Hayanga AJ, et al. Postcholecystectomy syndrome in the laparoscopic era [J]. J Laparoendosc Adv Surg Tech A, 2006; 16(5): 482-485.
  11. 11. Madácsy L, Fejes R, Kurucsai G, et al. Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction: effect of papillotomy [J].World J Gastroenterol, 2006; 12(42): 6850-6856.
  12. 12. 冉瑞圖. 發(fā)展中國(guó)特色的膽道外科 [J]. 中華肝膽外科雜志, 2006; 6(3): 163-165.
  13. 13. 榮萬水. 內(nèi)鏡保膽取石術(shù)與腹腔鏡膽囊切除術(shù)對(duì)患者生存質(zhì)量的影響 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(8): 23-25.
  14. 14. Grundy SM. Cholesterol gallstones: a fellow traveler with metabolic syndrome? [J]. Am J Clin Nutr, 2004; 80(1): 1-2.
  15. 15. Jiang ZY, Parini P, Eggertsen G, et al. Increased expression of LXR alpha, ABCG5, ABCG8, and SR-BI in the liver from normolipidemic, nonobese Chinese gallstone patients [J]. J Lipid Res, 2008; 49(2): 464-472.
  16. 16. Wang Y, Jiang ZY, Fei J, et al. ATP binding cassette G8 T400K polymorphism may affect the risk of gallstone disease among Chinese males [J]. Clin Chim Acta, 2007; 384(1-2): 80-85.
  17. 17. Kuo KK, Shin SJ, Chen ZC, et al. Significant association of ABCG5 604Q and ABCG8 D19H polymorphisms with gallstone disease [J]. Br J Surg, 2008; 95(8): 1005-1011.
  18. 18. 孔凡民, 隋春陽, 李航宇, 等. 膽囊膽固醇結(jié)石與肝細(xì)胞膽管膜上轉(zhuǎn)運(yùn)子BSEP、MRP2和MDR3關(guān)系的研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(3): 314-316..
  19. 19. Ure BM, De Jong MM, Bax KN. Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystolithiasis: a preliminary report [J]. Pediatr Surg Int, 2001; 17(5-6): 396-398.
  20. 20. 楊五計(jì), 胡安國(guó), 李志偉, 等. 經(jīng)皮膽鏡碎石清除術(shù)的術(shù)式及適應(yīng)證 [J]. 中華普通外科雜志, 2001; 16(6): 328-330.
  21. 21. Kellett MJ, Wickham JE, Russel RC. Percutaneous cholecystolithotomy [J]. Br Med J (Clin Res Ed), 1988; 296 (6620): 453-455.
  22. 22. 錢志平, 肖蔭祺, 李為民, 等. 經(jīng)皮膽囊碎石術(shù)的臨床應(yīng)用 [J]. 中華外科雜志, 1991; 29(10): 619-622.
  23. 23. 張冰, 荀祖武, 方榮興, 等. 經(jīng)皮膽鏡膽囊碎石清除術(shù): 附421報(bào)告 [J]. 中華外科雜志, 1991; 29(6): 350-351.
  24. 24. 蕭蔭祺, 錢志平, 許紅兵, 等. 經(jīng)皮膽囊碎石術(shù)的近期隨訪結(jié)果  [J]. 普外臨床, 1993; 8(4): 205-207.
  25. 25. 張寶善. 關(guān)于膽囊結(jié)石治療的爭(zhēng)論-與Langenbuch理論商榷 [J]. 中國(guó)醫(yī)刊, 2007; 42(5): 2-5.
  26. 26. 榮萬水. 微創(chuàng)膽囊切開取石術(shù)的臨床評(píng)價(jià) [J]. 中國(guó)內(nèi)鏡雜志, 2002; 8(12): 21-23.
  27. 27. 徐立友, 宋釗, 付廷海, 等. 623例內(nèi)鏡保膽取石術(shù) [J].中華消化外科雜志, 2007; 6(6): 459-461.
  28. 28. 陳培, 王炳生, 何連齊, 等. 上海地區(qū)膽囊結(jié)石復(fù)發(fā)的多因素分析 [J]. 中華普通外科雜志, 1998; 13(3): 134-136.
  29. 29. 鄒一平, 蕭蔭祺. 保膽取石術(shù)有關(guān)問題的探討 [J]. 中華肝膽外科雜志, 2009; 15(1): 1-3.
  30. 30. 劉衍民, 文輝清. 目前保留膽囊手術(shù)的幾個(gè)問題 [J]. 中華外科雜志, 2008; 4(10): 721-723.
  31. 31. 程國(guó)華, 隋晉平, 陸明. 經(jīng)皮膽鏡膽囊碎石取石術(shù)(附684例報(bào)告) [J]. 中國(guó)普通外科雜志, 1994; 3(1): 15-17.