胆囊管切开及其汇入部微切开入路术中胆道镜检查的临床价值  

Approach through slitting of cystic duct and microincision of its confluence part: clinical value of intraoperative cholangioscopy

作　　者：丁雄[1] 李生伟[1] 薛强[1] 龚建平[1] 

机构地区：[1]重庆医科大学附属第二医院肝胆外科,重庆400010

出　　处：《中国内镜杂志》2008年第4期373-374,378,共3页China Journal of Endoscopy

摘　　要：目的探讨经胆囊管切开及其汇入部微切开入路行术中胆道镜检查及取石治疗的效果。方法2003年5月～2006年11月具有胆总管探查指征的患者38例,开腹行胆囊切除术后,纵行切开胆囊管及其汇入部上下缘各约2mm,经此进行胆道镜检查和取石治疗。探查完成后,一期缝合胆总管切口及胆囊管。结果探查发现肝外胆管结石27例,阴性结果11例。术中发现结石共计56枚,结石取尽率100%,胆道镜检查或/和取石时间为2～35min,平均13min,进食后24h拔除引流管,均未发生胆漏,平均住院时间8.5d。术后3～6个月常规B超随访,均无胆道狭窄表现。35例得到随访,随访率92.1%(35/38),随访时间3～37个月,平均19个月。结论经胆囊管切开及其汇入部微切开入路术中胆道镜检查及治疗避免了术后安置T管,减少了并发症,缩短了住院时间,提高了患者的生存质量,是一种创伤小、安全、有效的方法。[Objective] To investigate the safety and clinical value of directly sewing common bile duct after intraoperative cholangioscopy through the approach of slitting of cystic duct and microincision of its confluence part. [Methods] Thirty-eight patients with exploration indications from May 2003 to November 2006 were observed. After cholecystectomy, cystic duct was slitted and the confluence part was cut open 2 mm at the supra and inferior margins. From this passage, choledochoscope was employed to inspect and extract stones. After this, the incision was sewed up directly. [Results] Extrahepatic bile duct stones were found in 27 cases and nothing was found in 11 cases. Fifty-six pieces of stones were extracted totally and the rate was 100%. The examination time was 2 to 35 minutes and the average time was 13 minutes. The drainage tube was pulled out 24 hours after eating, bile leakage was not found and the mean hospitalization time was 8.5 days. B ultrasound was employed routinely for 3 - 6 months＇ following up and biliary tract stenosis was not found. Thirty-five cases were followed up, the ratio was 92.1%（35/38） and the time was 3 months to 37 months with the average of 19 months. [Conclusion] Intraoperative cholangioscopy through the approach of slitting of cystic duct and microincision of its confluence part can avoid postoperative T tube drainage, decrease complications, shorten hospitalization time and sublime the existing quality, is a microtraumatic, safe and effective way.

关 键 词：胆囊管 胆道镜 胆道探查 

分 类 号：R575.623[医药卫生—消化系统]