摘要
胆囊切除术因其疗效确切成为了胆囊结石等胆囊良性疾病的标准治疗手段。但在保证手术治疗效果的前提下,尽可能减少给患者带来的创伤和功能损失,减少对患者术后生活质量的影响,是患者和外科医生共同的期望和追求。20世纪80年代,国内外均有外科医生采用胆囊内碎石、留置引流管的方式开展保胆手术,称之为旧式保胆取石术,不过因其术后结石高复发率等争议归于沉寂。1992年国内张宝善教授采用胆道镜开展保胆手术,放弃了胆囊内碎石、留置引流管的方式,注重胆道镜直视下的观察与操作,有效避免了结石的残留,极大降低了术后结石的复发率,称之为新式保胆手术。新式保胆手术自倡导以来,始终伴随着争议,争议的焦点依然是结石的复发,同时保胆取石术后的胆囊作为胆囊癌的危险因素也成为争议的焦点。科学的发展总是伴随着争议与讨论,这有助于厘清认识,促进不同观点学者间的交流、合作,推动科学的进步。笔者回顾文献,结合个人经验,旨针对保胆手术中的争议展开讨论、分析。
Cholecystectomy has become the standard treatment for gallbladder stones and other benign gallbladder diseases because of its efficacy.However,ensuring the effectiveness of surgical treatment,minimizing the trauma and functional loss to patients,and reducing the impact on their postoperative quality of life is the common expectation and pursuits of patients and surgeons.In the 1980s,surgeons at home and abroad used intracystic lithotripsy and indwelling drainage tube to carry out bile-sparing surgery,which has been called the old type of gallbladder-preserving surgery.However,the controversies surrounding it eventually subsided,due to the limitations such as a high postoperative recurrence rate of stones.In 1992,Prof.Zhang Baoshan adopted the choledochoscopy to carry out biliary surgery,giving up the way of intracystic lithotripsy and indwelling drainage tube and focusing on the observation and operation under the direct vision of choledochoscopy,which effectively avoids the residual stones and greatly reduces the recurrence rate of postoperative stones,which is called the new type of gallbladderpreserving surgery.Since the introduction of the new surgical type,it has always been accompanied by controversy,and the focus of the debate is still the recurrence of stones and the gallbladder after biliary lithotripsy as a risk factor for gallbladder cancer has also become the focus of controversy.Arguments and discussion always be the companion of scientific development,which helps to clarify understanding,promote communication and cooperation among scholars with different viewpoints,and promote the progress of science.Reviewing the literature and combining personal experience,the author aims to discuss and analyze the controversies in biliary conservation surgery.
作者
吕文才
LU Wencai(Department of Hepatobiliary Surgery,Dalian Friendship Hospital Affiliated to Dalian Medical University,Dalian,Liaoning 116001,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2023年第8期1237-1245,共9页
China Journal of General Surgery
关键词
胆囊结石病
器官保留治疗
胆囊切除术
复发
胆囊肿瘤
综述
Cholecystolithiasis
Organ Sparing Treatments
Cholecystectomy
Recurrence
Gallbladder Neoplasms
Review
