螺旋CT三维胆道成像对腹腔镜胆囊切除术前胆道结构评估的研究  

Evaluation of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy

作　　者：王红禄[1] 赵振生[1] 曹双军[1] 李晋[1] 石庆龙[1] 李旭彤[1] 

机构地区：[1]首都医科大学良乡教学医院普外科,北京102401

出　　处：《国际外科学杂志》2013年第1期19-21,F0003,共4页International Journal of Surgery

基　　金：首都医学发展基金（No.2007-3150）

摘　　要：目的探讨螺旋CT三维胆道成像在腹腔镜胆囊切除术前对胆道结构的评估。方法回顾性分析2009年5月-2012年4月胆囊结石合并胆总管结石患者60例，先行内镜下逆行胰胆管造影、内镜下乳头括约肌切开术及内镜下鼻胆引流术，通过鼻胆引流管行螺旋CT三维胆道成像，评价螺旋CT三维胆道成像图像质量，了解胆道树结构，再行腹腔镜胆囊切除术。结果螺旋CT三维胆道成像60例，胆总管、肝总管、左右肝管显影60例，显影率100％，胆囊管显影45例，显影率为75％，可清晰显示胆囊管的走行及汇入胆总管的位置。结论螺旋CT三维胆道成像可清晰显示胆道树结构，尤其是胆囊管的走行，为腹腔镜胆囊切除术中判断胆道树结构及胆囊管走行，防止胆道损伤有一定的指导意义。Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration be- fore laparoscopic cholecystectomy. Methods A retrospective analysis was performed for 60 patients with cholelithia- sts concurrent with choledocholithiasis from May 2009 to April 2012, which were treated with endoscopic retrograde cholangiopancreatography （ERCP）, endoscopic sphincterotomy （EST）, and endoscopic nasobiliary drainage （EN- BD）, then three-dimensional spiral CT cholangiography（SCTC） was performed through endoscopic nasobiliary drain- age （ENBD） tube, and the bile duct tree image of SCTC was evaluated, then laparoscopic cholecystectomy （LC） was carried out. Results Sixty cases were performed three-dimensional SCTC. The left and right hepatic bile ducts, the hepatic bile duct and the common bile duct were visible in 100% patients, and cholecyst bile duct was visible in 75% patients, and three-dimensional SCTC can tell the position of cholecyst duct and the place where tile cholecyst bile duct enteres into the common bile duct. Conclusion Three-dimensional SCTC can show the shape of bile duct tree, especially the cholecyst duct, and has some guidance values to judge the structure of the bile duct tree and the config- uration of cholecyst bile duct during operation, which can decrease the possibility of bile duct injure.

关 键 词：体层摄影术 螺旋计算机 成像 三维 内镜下逆行胆胰管造影 胆囊切除术 腹腔镜 胆道损伤 

分 类 号：R657.4[医药卫生—外科学]