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1993年5月至1995年1月,我们共为15例胆囊息肉样病变的病人作了经皮胆镜息肉摘除术。其小男4例,女11例,平均46岁(39～61岁)。选择指征:(1)术前B超检查确定为胆囊息肉样病变;(2)口服胆囊造影显示胆囊收缩和浓缩功能良好;(3)B超检查示胆囊壁厚度≤5mm;(4)病变直径<10mm;(5)叻缘下B超体表定位可探及胆囊。 操作技巧 持续硬膜外麻醉,根据术前胆囊体表定位点处作一小横切口(2cm±),用血管钳分离肌层进腹,提胆囊底至腹膜外。胆囊壁戳孔,置胆镜鞘,吸尽胆囊内胆汁,插入胆道镜窥视,找到病灶后在其蒂根部(必要时带点正常粘膜)用活检钳摘除。此时往往有少量渗血,经冲洗和吸引后即能自停。然后将标本送冰冻切片,最后用吸收缝线关闭胆囊壁及腹壁切口。平均时间约40分钟。
From May 1993 to January 1995, we performed a total of 15 patients with polypoid lesions of the gallbladder who underwent percutaneous bileoscopic polypectomy. There were 4 males and 11 females with an average age of 46 (39 to 61 years). Selection indications: (1) Preoperative B-ultrasound was determined as gallbladder polypoid lesions; (2) Oral cholecystography showed good gallbladder contraction and concentration; (3) B-ultrasound showed gallbladder wall thickness ≤ 5 mm; (4) lesions Diameter <10mm; (5) The B-ultrasonic surface positioning under the temporal border can be used to explore the gallbladder. Operating skills Continuous epidural anesthesia, according to the preoperative gallbladder body surface positioning point for a small transverse incision (2cm ±), with vascular forceps to separate the muscle into the abdomen, lift the gallbladder bottom to the extraperitoneal. The gallbladder wall was punched and the gallbladder sheath was placed. The gallbladder bile was drained. The gallbladder was inserted and peeped. After the lesion was found, it was removed at the pedicle base (needed with normal mucosa when necessary) with a biopsy forceps. At this time there is often a small amount of bleeding, which can stop after flushing and suction. The specimens were then sent to frozen sections, and the gallbladder wall and abdominal wall incisions were closed with absorbent sutures. The average time is about 40 minutes.