Clinical Analysis Of Preservation Of Gallbladder And Removal Of Calculus By Laparoscopy Combined With Choledochoscopy

Cholecystolithiasis is a kind of common and frequently–occurring diseasein clinic. The incidence of cholecystolithiasis had a tendency to increase everyyear in recent years. According to statistics, the incidence of cholecystolithiasisamong chinese adult is about10%, and the middle-aged women even to15%.The incidence is as high as8.8~17.0%among healthy check-up of the crowdaged between31to70. Cholecystolithiasis brings our health great harm, Inextreme cases attacks can be fatal. So cholecystolithiasis must be treated assoon as possible. There’re many methods and means of treatment, such aslithotripsy, Gallstone dissolve, Gallstone Exclusion, surgery and so on. But themain method is still surgery. In1882German doctors Langenbuchpropounded a theory that Cystic resection not only because of the gallbladdercontains stones，but also because it grow stone in the gallbladder，in what wascalled” theory of the forcing bed” later, and then propounded that the besttreatment is cholecystectomy. Cholecystectomy is regarded as the goldenstandard of treatment cholecystolithiasis. This golden standard was followedmore than100years, it seems to have an inexorable academic status. With theappearance of the first case on laparoscopic cholecystectomy in the world, theMinimally Invasive Skill was applied in cholecystectomy, and laparoscopiccholecystectomy was accepted by patients at large for its little trauma、lesspain、rapid recovery and good beautiful body effect. Because of the rapiddevelopment of Minimally Invasive Surgery technology of endoscope andlaparoscope and With the deepening of cognition of postoperativepathphysiological influence and cystic function, concepts and consciousness ofpreservation of gallbladder and removal of calculus is growing stronger day by day. Cystic resection is not the best choice for all cholecystolithiasis patients,preservation of gallbladder and removal of calculus is expected to becomecholecystectomy replacement therapy for that cholecystolithiasis patients whohave good cystic function. In this paper we retrospectively reviewed25casesof cholecystolithiasis patients (10cases of preservation of gallbladder andremoval of calculus,15cases of LC patients) in Our Hospital, and compareeffects of both treatment of cholecystolithiasis. The aim is to discuss theinfluence factors of cholecystolithiasis for cystic contractive function,summarize the surgical indications of the preservation of gallbladder andremoval of calculus by laparoscopy combined with choledochoscopy, anddefine clinical application value of preservation of gallbladder and removal ofcalculus.Objective：Combined with the clinical data of preservation of gallbladderand removal of calculus and cholecystectomy patients, Analysis of theinfluence factors of cholecystolithiasis for cystic contractive function,elementarily discuss the surgical indications and clinical application value ofthe preservation of gallbladder and removal of calculus.Methods：Divide25cases of cholecystolithiasis patients into two groups,10cases of preservation of gallbladder and removal of calculus patients and15cases of LC patients. All cases received pre-operation ultrasound and foundcholecystolithiasis. The cases of preservation of gallbladder and removal ofcalculus patients received pre-operation meals fat examination. Themultivariate analyses were used in group of PG, including length of medicalhistory, accompanied symptoms, frequency of symptoms, wall thickness,number and size of the stones and so on, discuss the influence factors ofcholecystolithiasis for cystic contractive function. Statistically analysis the age,sex, operation time, the postoperative length of hospital stay, the postoperativecomplications, symptoms relief status, in hospital cost, time of removed T-tube of both groups’ patients, and then elementarily discuss the surgical indicationsand clinical application value of the preservation of gallbladder and removal ofcalculus.Results：This group of25patients age21-60years old, an average of47.6years, female over male (male-8cases, female-17cases), male-to-female ratiowas1:2.1.9patients were found in the physical examination,16patientshospitalized for the pain in the right upper abdomen and in the back of the rightshoulder, disgusted greasy diet.25patients are considering cholecystolithiasiswith cholecystitis before operative. Always without obstructive jaundice andpancreatitis history, all the cases were treated by surgical methods. Two groupsof patients were successful operation All the operations were performedsuccessfully, operation time53-120min, an average of75min. The patients ofPG group didn’t have residual stones and no postoperative complications,removed T-tube for an average of two days and left hospital successfully.Abdominal distension occurred in2cases of LC group, which were alleviatedafter medication. All cases were followed up for1~2years, There was norecurrence of gallbladder stone on the average of13months. the gallbladderwall thickness of PG group were improved obviously thin (P <0.05) and thecholecystolithiasis for cystic contractive function recovered well.Conclusions：This paper despite the small number, but based on thediscussion result, we think that meet the following conditions can considerpreservation of gallbladder and removal of calculus by laparoscopy combinedwith choledochoscopy:1、 Gallbladder contractive function is good，and the gallbladder wallthickness <4mm.2、The stones are less than5pieces in Number, and the length-diameter isless than2.5cm, the symptom is happening in accident.