CN105581822A - CIT multi-endoscope combined stone extraction techniques with gallbladder preserved - Google Patents
CIT multi-endoscope combined stone extraction techniques with gallbladder preserved Download PDFInfo
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- CN105581822A CN105581822A CN201610101576.6A CN201610101576A CN105581822A CN 105581822 A CN105581822 A CN 105581822A CN 201610101576 A CN201610101576 A CN 201610101576A CN 105581822 A CN105581822 A CN 105581822A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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- A61M1/0058—
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M3/00—Medical syringes, e.g. enemata; Irrigators
- A61M3/02—Enemata; Irrigators
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22079—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with suction of debris
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/10—Trunk
- A61M2210/1042—Alimentary tract
- A61M2210/1075—Gall bladder
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Abstract
The invention discloses two CIT multi-endoscope combined stone extraction techniques with gallbladder preserved. According to one technique, stone extraction with gallbladder preserved is conducted by means of a peritoneoscope and a choledochoscope assisted by the peritoneoscope, a patient is in the supine position, the bottom of the gallbladder is pulled out of the abdomen with peritoneoscope gripping tongs, an incision which is 1.0-1.5 cm in size is cut with an electrocoagulation hook on the bottom of the gallbladder, a rubber hose is inserted in and gall is extracted with an injector, the choledochoscope is inserted in, stone is taken out, the choledochoscope is retracted, and then the incision on the bottom of the gallbladder is sutured. According to the other technique, stone extraction with gallbladder preserved is conducted in a total laparoscopic mode, a patient is in the dorsal elevated position, an incision which is 1.0-1.5 cm in size is cut with an electrocoagulation hook on the bottom of the gallbladder, electrocoagulation hemostasis is conducted, a rubber hose is inserted in through a Trocar hole 10 mm away from the body projection position on the bottom of the gallbladder, gall is extracted with an injector, a choledochoscope is inserted in, stone is taken out, the choledochoscope is retracted, and then the incision on the bottom of the gallbladder and the gallbladder are sutured. The two CIT multi-endoscope combined stone extraction techniques with gallbladder preserved have the advantages that the gallbladder can be found quite easily, the incision is small, and the beautifying effect is good; the first technique is easy to operate when used for abdominal external stone or polyp extraction, and the second technique is suitable for all situations with gallbladder preserved.
Description
Technical field
The present invention relates to two kinds of operation methods, be specifically related to two kind of three mirror associating protect gallbladder take stone art.
Background technology
At present, the operation of carrying out for cholecystolithiasis (polyp), some problems below main existence:
1, find comparatively complexity of gall-bladder, and be not easy operation;
2, get stone operation inconvenience, the time is long;
3, suturing skill requires high;
4, otch is large.
Summary of the invention
For solving the deficiencies in the prior art, the object of the present invention is to provide two kind of three mirror associating protect gallbladder take stone art, these two kinds of operation methods have the advantages such as the gall-bladder of searching is very easy, and otch is little, and cosmetic result is good.
In order to realize above-mentioned target, the present invention adopts following technical scheme:
A kind of three mirror associating protect gallbladder take stone arts, is characterized in that, adopt the auxiliary choledochoscope of laparoscope to carry out protect gallbladder take stone, comprise the following steps:
(1) patient gets dorsal position, after general anesthesia success, under navel, puncture is inserted veress needle and is built pneumoperitoneum, pneumoperitoneum pressure is 12-14mmHg, 10mmTrocar puncture, inserts laparoscopic approach, determine gallbladder wall smooth, without after abnormal, under laparoscope monitors, at the bottom of nearly gall-bladder, body surface projection place puncture is inserted 10mmTrocar, gall-bladder bottom is lifted out outside abdomen with laparoscope grasping forceps through this hole;
(2) otch of 1.0-1.5cm size at the bottom of electricity consumption hook incision gall-bladder, inserts sebific duct and extracts bile out with syringe, then insert choledochoscope, uses normal saline flushing gallbladder mucosa;
(3) take out calculus, for cholecystolithiasis: with stone extraction basket, calculus is taken out one by one under choledochoscope or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, Microlithiasis or muddy stone are exhausted by normal saline flushing attraction method; For optimum gallbladder polyps: directly capture with biopsy forceps or nipper under choledochoscope;
(4) check gallbladder mucosa, cystic duct opening, guarantee the unobstructed backed off after random choledochoscope of cystic duct;
(5), with 4-0 absorbable thread continuous holostrome, double breasted suture gall-bladder undercut, reproduces pneumoperitoneum after also including gall-bladder in abdominal cavity.
Aforesaid three mirror associating protect gallbladder take stone arts, is characterized in that, in step (1), show that for preoperative B ultrasonic gall-bladder is the situation that muddy stone or calculus are more and differ in size, first with clamping neck of gallbladder without wound blood vessel clip or satinsky's clamp.
A kind of three mirror associating protect gallbladder take stone arts, is characterized in that, adopt full laparoscope to carry out protect gallbladder take stone, comprise the following steps:
(1) patient gets head height foot low level, and after general anesthesia success, under laparoscope, electricity consumption is hooked in gall-bladder bottom and cuts 1.0-1.5cm, electric coagulation hemostasis;
(2) at the bottom of nearly gall-bladder, sebific duct is inserted in 10mmTrocar hole, body surface projection place, extracts bile out with syringe, then inserts choledochoscope, uses normal saline flushing gallbladder mucosa;
(3) take out calculus, for cholecystolithiasis: with stone extraction basket, calculus is taken out one by one under choledochoscope or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, Microlithiasis or muddy stone are exhausted by normal saline flushing attraction method; For optimum gallbladder polyps: directly capture with biopsy forceps or nipper under choledochoscope;
(4) under choledochoscope, check that gallbladder mucosa has not damaged, hemorrhage, get Shi Wanhou repeatedly physiological saline+gentamicin be irrigating solution rinse;
(5) guarantee the unobstructed backed off after random choledochoscope of cystic duct, under laparoscope, with the continuous holostrome of 4-0 absorbable thread, double breasted suture gall-bladder undercut, sews up gall-bladder with 4m absorbable thread, sets up pneumoperitoneum, visits apricot abdominal cavity, and gall-bladder finishes operation after leaking without hemorrhage and courage.
Aforesaid three mirror associating protect gallbladder take stone arts, is characterized in that, in step (4), the in the situation that of mucous membrane bleed bottom, add salt solution spray hemostasis with norepinephrine 4mL.
Aforesaid three mirror associating protect gallbladder take stone arts, is characterized in that, in step (5), after double breasted suture gall-bladder undercut, a peritoneal cavity drainage tube is placed in Winslow hole.
Usefulness of the present invention is:
(1) for the auxiliary choledochoscope protect gallbladder take stone of laparoscope, it is found, and gall-bladder is very easy, and otch is little, and cosmetic result is good, gets stone (polyp) outward at abdomen, operates easier;
(2) for protect gallbladder take stone under laparoscope, it is found, and gall-bladder is very easy, and otch is little, and cosmetic result is good, is suitable for the situation of all various guarantor's courages.
Detailed description of the invention
Below in conjunction with specific embodiment, the present invention is done to concrete introduction.
One, indication
1, there are symptom (in 3 months without acute attack) or asymptomatic single-shot or multiple cholecystolithiasis (polyp), all feasible guarantor's courage operations in disease time 72h.
If disease time is greater than 72h, should consider following situation:
(1) repeatedly send out author, adhesion is serious and fine and close, and operating difficulty is large;
(2) disease time is longer, and operating difficulty is larger; Transfer laparoscopic cholecystectomy patient duration of seizure is all longer;
(3) body temperature is greater than 38 DEG C (being particularly greater than 39 DEG C) and continues the above person of 3d, and tissue inflammation is heavy, fragility is high, and even downright bad, gall-bladder pathology is serious, easily causes bile duct injury and titanium and presss from both sides and come off;
(4) preoperative B ultrasonic can accurately be observed gall-bladder wall thickness and stone location, and gall-bladder wall thickness is less than 5mm, all can complete operation; The possibility of 8-10mm and above person's transfer operation obviously increases.
2, preoperative B ultrasonic mensuration gallbladder contraction function is good.
Be determined with function cholecystolithiasis condition:
(1) gallbladder wall polishing and without obviously thickening, ultrasonic mensurations empty stomach is greater than 30% with gallbladder contraction area after the meal;
(2) there are light symptoms and medical history shorter one;
(3) single-shot cholecystolithiasis or multiple cholecystolithiasis are less than 3 and diameter and are less than 3cm.
The cholecystolithiasis that meets above-mentioned 3 conditions is called function cholecystolithiasis.
Retain the heavier gall-bladder of those nonfunctionals or inflammation, equal to stay in vivo focus, postoperative gallbladder contraction function is bad, cholestasis, recurrence of hepatolithiasis.
3, gall-bladder wall thickness≤3mm.
4, cystic duct is unobstructed without calculus incarceration, and lower common bile duct is without blocking.
5, without atrophic cholecystitis, porcelain gall-bladder; Cholecystolithiasis merges polypoid pathology or is suspected to have carcinoma of gallbladder person.
6, bring out acute festering type or gangrenous cholecystitis, acute or chronic pancreatitis without cholecystolithiasis; In bile duct, merge calculus or other severe complications.
7, without the excision of the large portion of stomach, the upper abdominal surgery histories such as stomach intestinal anastomosis, without severe cardiac, liver, lung disease and dysfunction and coagulation disorders medical history.
8, patient and family members have the requirement of strong guarantor's courage.
Other:
1, Symptomatic cholecystolithiasis. But for without acute attack, especially for young patient, only there is the patient of slight upper indigestion symptom, as glutted, heating installation, if gallbladder function is normal, feasible protect gallbladder take stone art; As for child patient, Ure etc. are comparing after the Follow-up Data of protecting courage and 2 groups, excision gall-bladder, propose Symptomatic cholecystolithiasis infant to be advisable to protect courage operation.
2, multiple cholecystolithiasis or muddy stone. Fiber endoscopy can be detected gall-bladder inner case comprehensively in theory, and Relapse rate and preoperative calculus number are irrelevant, but also has check experiment to find, calculus outnumbers 3 pieces of person's Postoperative recurrent rates apparently higher than being less than 3 pieces of persons.
3, calculus diameter is greater than 2cm. No matter Schirmer etc. think the size of calculus, the feasible protect gallbladder take stone art of the normal patient of gallbladder function, thinks that calculus diameter is greater than the high risk factor that 2cm is carcinoma of gallbladder, is advisable to excise gall-bladder but also have.
4, there is adhesion in peribiliary. Certainly whether adhesion can limit gallbladder contraction, affect gall bladder emptying, causes Relapse rate and increases and wait to study.
5, gall-bladder is less, position is high. This situation also can directly be cut gall-bladder bottom under laparoscope, inserts fiber endoscopy.
Two, contraindication
1, atrophy of gallbladder, thickening of capsule wall of gallbladder, gall-bladder chamber disappears, and merges choledocholithiasis person.
2, calculus cannot be taken out in cystic duct, estimate postoperative still cannot taking-up person.
3, cystic duct confirms through Photographg the person of blocking.
4, Mirizz syndrome.
5, confirm that gall-bladder has completely lost function.
6, in art, B ultrasonic radiography is shown in calculus in cystic duct, and in art, choledochoscope cannot finder.
7, in poor condition of health, preoperative assessment can not tolerate surgery person.
8, gall-bladder is at acute inflammation stage (comprising suppuration, gangrene, perforation, inflammatory parcel).
9, gall-bladder gland flesh disease or the thickening of capsule wall of gallbladder person that can not get rid of carcinoma of gallbladder.
10, the large portion of stomach excision, the upper abdominal surgery histories such as stomach intestinal anastomosis, severe cardiac, liver, lung disease and coagulation disorders medical history.
11, the not good enough person for the treatment of diabetes effect.
Three, disease principle
1, gall stone is more common a kind of disease at present life, anyly affects cholesterol with the change of bile acid concentration ratio and causes the factor of cholestatis can cause calculus.
2, hotbed theory: German generation well-known doctor Langenbuch1882 creates. Under the backward condition without endoscopic technic at that time, he thinks that old-fashioned gall-bladder lithotony treatment cholecystolithiasis is not thorough, postoperative easy recurrence (> 90%); The judgement that therefore he has proposed " gallbladder removal not only contains calculus because of gall-bladder, but also because it can be grown calculus ", this is famous " hotbed theory.
Four, anesthesia
Etomidate, suitable atracurium, fentanyl, intravenous injection induction, infusion Propofol, fentanyl after trachea cannula, be interrupted injection along atracurium and suck sevoflurane maintaining anesthesia, art finishes treats that patient is clear-headed, and fully after suction sputum, tube drawing, oxygen uptake treat that patient steward scoring 5-6 is distributed into ward.
Five, operation technique
Embodiment 1: laparoscope is assisted choledochoscope protect gallbladder take stone
1, patient gets dorsal position, after general anesthesia success, under navel, puncture is inserted veress needle and is built pneumoperitoneum, pneumoperitoneum pressure is 12-14mmHg, 10mmTrocar puncture, inserts laparoscopic approach, determine gallbladder wall smooth, without adhesion, without thicken and without obvious chronic inflammation etc. other abnormal after, under laparoscope monitors, at the bottom of nearly gall-bladder, body surface projection place puncture is inserted 10mmTrocar, gall-bladder bottom is lifted out outside abdomen with laparoscope grasping forceps through this hole.
Be that muddy stone or calculus are more and differ in size as preoperative B ultrasonic shows gall-bladder, for preventing in art in gall-bladder that Microlithiasis falls people's bile duct, secondary calculus of bile duct, can be first with clamping neck of gallbladder without wound blood vessel clip or satinsky's clamp.
2, the otch of 1.0-1.5cm size at the bottom of electricity consumption hook incision gall-bladder, insert sebific duct and extract bile out with syringe, then insert choledochoscope, limit normal saline flushing gallbladder mucosa, the situation of gallbladder mucosa, quantity, the size and location of cholecystolithiasis (polyp) are observed in limit.
3, take out calculus, calculus is taken out and is all operated with choledochoscope.
As be cholecystolithiasis, under choledochoscope, with stone extraction basket, calculus taken out one by one or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, avoid being caught broken calculus, Microlithiasis or muddy stone can be exhausted by normal saline flushing attraction method.
As be gallbladder polyps, under choledochoscope, directly capture with biopsy forceps or nipper, send immediately quick frozen-section, as be optimum, continue to protect courage art; As be pernicious, conversion into open surgery operation.
4, check that gallbladder mucosa has not damaged, hemorrhage, check that cystic duct opening has bile to gush out, prove the unobstructed backed off after random choledochoscope of cystic duct, with the continuous holostrome of 4-0 absorbable thread, double breasted suture gall-bladder undercut, after also including gall-bladder in abdominal cavity, reproduce pneumoperitoneum, abdominal cavity Microscopic observation has or not that courage leaks, hemorrhage and liver bed damage etc., does not generally need placing drainage.
Embodiment 2: protect gallbladder take stone under full laparoscope
1, patient gets head height foot low level, and after general anesthesia success, under laparoscope, electricity consumption is hooked in gall-bladder bottom and cuts 1.0-1.5cm, electric coagulation hemostasis.
2, take out calculus, calculus is taken out and is all operated with choledochoscope. At the bottom of nearly gall-bladder, sebific duct is inserted in 10mmTrocar hole, body surface projection place, extracts bile out with syringe, then inserts choledochoscope, limit normal saline flushing, the situation of limit observation gallbladder mucosa, quantity, the size and location of cholecystolithiasis (polyp).
As be cholecystolithiasis, under choledochoscope, with stone extraction basket, calculus taken out one by one or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, avoid being caught broken calculus, Microlithiasis or muddy stone can be exhausted by normal saline flushing attraction method.
As be gallbladder polyps, under choledochoscope, directly capture with biopsy forceps or nipper, send immediately quick frozen-section, as be optimum, continue to protect courage art; As be pernicious, conversion into open surgery operation, takes out calculus (polyp) and puts into specimen bag or directly catch.
3, under choledochoscope, check that gallbladder mucosa has not damaged, hemorrhage, get Shi Wanhou repeatedly physiological saline+gentamicin be irrigating solution rinse, if any mucous membrane bleed bottom, available norepinephrine 4mL add salt solution spray hemostasis.
4, inspection cystic duct opening is shown in that the white cystic duct of bile flows into gall-bladder chamber, prove the unobstructed backed off after random choledochoscope of cystic duct, under laparoscope, use the continuous holostrome of 4-O absorbable thread, double breasted suture gall-bladder undercut, observation has or not courage leakage, hemorrhage and liver bed damage, Winslow takes the circumstances into consideration in hole to place a peritoneal cavity drainage tube, after courage intracystic stones takes, because of hydrocholecystis, hyperemia, under Ying Jing, go through, with cleaning down, exhaustion irrigating solution, with 4m absorbable thread stitching gall-bladder, set up pneumoperitoneum, visit apricot abdominal cavity, gall-bladder finishes operation after leaking without hemorrhage and courage.
Six, Surgical Operation contrast
Two kinds of art formulas that embodiment 1 and embodiment 2 record respectively have pluses and minuses.
The operation method that embodiment 1 records, advantage: find gall-bladder very easy, otch is little, and cosmetic result is good, gets stone (polyp) outward at abdomen, operates easier; Shortcoming: can only be applicable to the longer part patient in gall-bladder bottom, celioscope pneumoperitoneum is unfavorable to the elderly and cardiovascular patient.
The operation method that embodiment 2 records, advantage: find gall-bladder very easy, otch is little, and cosmetic result is good, is suitable for the situation of all various guarantor's courages; Shortcoming: operation is comparatively complicated, sews up gall-bladder and choledochoscope and gets stone operation inconvenience, and the time is long, and suturing skill requires high, as sewed up imprecision, courage may occur and leak, and abdominal cavity is easily polluted by bile, also exists pneumoperitoneum to the elderly and cardiovascular patient disadvantage.
Seven, the observation of postoperative complications and nursing
1, hemorrhage
Hemorrhagely generally occur in postoperative 24-28h, therefore postoperative should every 15-30min measuring blood pressure, pulsation 1 time, after steadily, 1-2h measures 1 time, and observe patient's complexion, mind changes, and observes otch oozing of blood situation, make a record in time. General hemorrhage is that gall-bladder otch oozing of blood or mucous membrane of gallbladder are hemorrhage, and amount of bleeding is generally little. The postoperative short time haemostatic medicament that gives, gives fibrin ferment if desired. For the hemorrhage more person of special circumstances, can give with laparoscope under electric coagulation hemostasis. Preoperative four of the blood clottings of having looked into.
2, courage leaks
Suffer from abdominal pain situation and have or not abdominal cavity to stimulate disease of postoperative close observation patient, as patient has stomachache violent, with abdominal cavity irritation, should notify doctor to process immediately.
3、C02Complication after pneumoperitoneum
C02Blood vessel dilatation under pneumoperitoneum posterior peritoneum and gastrointestinal serosa, C02Fill the air into blood and produce hypercapnia and acid poisoning, C02Gather under diaphragm, neural under stimulation diaphragm, hinder veins of lower extremity and reflux, cause that shoulder is carried on the back and two lower limb are ached, residue in human body open texture and cause pneumoderm.
4, other
The postoperative symptoms such as having or not tired, fidgety, tachypnea of should observing, gives low discharge oxygen uptake, notes warmingly, gets semireclining position and have a rest after anesthesia is clear-headed, assists to stand up, clap the back of the body, encourages effective C & DB.
Eight, postoperative movable guidance
Postoperative early ambulant can promote enterocinesia, improves respiratory function, prevents pulmonary complication, and prevention of deep vein thrombosis occurs.
When anesthesia of patient is clear-headed, after vital signs stable, i.e. desirable semireclining position, do in bed four limbs stretch bend movable. Can assist patient's Go to ground activity morning next day.
It should be noted that, above-described embodiment does not limit the present invention in any form, and all employings are equal to replaces or technical scheme that the mode of equivalent transformation obtains, all drops in protection scope of the present invention.
Claims (5)
1. three mirror associating protect gallbladder take stone arts, is characterized in that, adopt the auxiliary biliary tract of laparoscopeMirror carries out protect gallbladder take stone, comprises the following steps:
(1) patient gets dorsal position, and after general anesthesia success, under navel, puncture is inserted veress needle and builtGas making abdomen, pneumoperitoneum pressure is 12-14mmHg, 10mmTrocar puncture is inserted laparoscope and is visitedLook into, determine gallbladder wall smooth, without after abnormal, under laparoscope monitors, at the bottom of nearly gall-bladder, body surface is thrownShadow place puncture is inserted 10mmTrocar, gall-bladder bottom is lifted out with laparoscope grasping forceps through this holeOutside abdomen;
(2) otch of 1.0-1.5cm size at the bottom of electricity consumption hook incision gall-bladder, inserts injection for sebific ductDevice is extracted bile out, then inserts choledochoscope, uses normal saline flushing gallbladder mucosa;
(3) take out calculus, for cholecystolithiasis: under choledochoscope with stone extraction basket by calculus one by oneTake out or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, Microlithiasis or silt sample are tiedStone is exhausted by normal saline flushing attraction method; For optimum gallbladder polyps: under choledochoscope with livingInspection pincers or nipper directly capture;
(4) check gallbladder mucosa, cystic duct opening, guarantee the unobstructed backed off after random choledochoscope of cystic duct;
(5) with the continuous holostrome of 4-0 absorbable thread, double breasted suture gall-bladder undercut, by gall-bladder alsoAfter including abdominal cavity in, reproduce pneumoperitoneum.
2. three mirror associating protect gallbladder take stone arts according to claim 1, is characterized in that,In step (1), show that for preoperative B ultrasonic gall-bladder is that muddy stone or calculus are more and big or smallSituation about not waiting, first with clamping neck of gallbladder without wound blood vessel clip or satinsky's clamp.
3. three mirror associating protect gallbladder take stone arts, is characterized in that, adopt full laparoscope to protectCourage is got stone, comprises the following steps:
(1) patient gets head height foot low level, and after general anesthesia success, under laparoscope, electricity consumption is hooked in1.0-1.5cm, electric coagulation hemostasis are cut in gall-bladder bottom;
(2) at the bottom of nearly gall-bladder, sebific duct is inserted in 10mmTrocar hole, body surface projection place, with injectionDevice is extracted bile out, then inserts choledochoscope, uses normal saline flushing gallbladder mucosa;
(3) take out calculus, for cholecystolithiasis: under choledochoscope with stone extraction basket by calculus one by oneTake out or by biopsy forceps under rigid choledochoscope or nipper gripping calculus, Microlithiasis or silt sample are tiedStone is exhausted by normal saline flushing attraction method; For optimum gallbladder polyps: under choledochoscope with livingInspection pincers or nipper directly capture;
(4) under choledochoscope, check that gallbladder mucosa has not damaged, hemorrhage, get Shi Wanhou physiology repeatedlySalt solution+gentamicin is that irrigating solution rinses;
(5) guarantee the unobstructed backed off after random choledochoscope of cystic duct, under laparoscope, connect with 4-0 absorbable threadContinuous holostrome, double breasted suture gall-bladder undercut, sews up gall-bladder with 4m absorbable thread, sets up pneumoperitoneum,Visit apricot abdominal cavity, gall-bladder finishes operation after leaking without hemorrhage and courage.
4. three mirror associating protect gallbladder take stone arts according to claim 3, is characterized in that,In step (4), the in the situation that of mucous membrane bleed bottom, with norepinephrine, 4mL adds salt solutionSpray hemostasis.
5. three mirror associating protect gallbladder take stone arts according to claim 3, is characterized in that,In step (5), after double breasted suture gall-bladder undercut, Winslow hole is placed an abdominal cavity and is drawnStream pipe.
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107970056A (en) * | 2017-12-19 | 2018-05-01 | 孔新亮 | A kind of liver and gall surgical department is with taking stone device and method thereof |
| CN109091175A (en) * | 2018-07-27 | 2018-12-28 | 上海市东方医院 | It protects gallbladder and takes stone/polyp choledochoscope protection sheath |
| CN113633252A (en) * | 2021-08-15 | 2021-11-12 | 杨冬梅 | Gallbladder-protecting mirror for minimally invasive cystic duct exploration |
-
2016
- 2016-02-24 CN CN201610101576.6A patent/CN105581822A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107970056A (en) * | 2017-12-19 | 2018-05-01 | 孔新亮 | A kind of liver and gall surgical department is with taking stone device and method thereof |
| CN109091175A (en) * | 2018-07-27 | 2018-12-28 | 上海市东方医院 | It protects gallbladder and takes stone/polyp choledochoscope protection sheath |
| CN113633252A (en) * | 2021-08-15 | 2021-11-12 | 杨冬梅 | Gallbladder-protecting mirror for minimally invasive cystic duct exploration |
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