选择性术中胆囊-胆管造影在内镜微创保胆中的应用  

The application of selected intraoperative gallbladder-cholangiography during cholecystolithotomy with gallbladder preserved

作　　者：李全福[1] 葛新[2] 许旭[2] 刘建辉[2] 张立广[2] 邵青龙[2] 郭超[2] 钟永刚[2] 

机构地区：[1]卫生部肝胆肠外科研究中心,湖南长沙410008 [2]卫生部内镜与微创专业技术培训基地(河北省保定市第二医院肝胆外科),河北保定071051

出　　处：《中国内镜杂志》2013年第1期39-41,共3页China Journal of Endoscopy

摘　　要：目的探讨选择性术中胆囊-胆管造影在保胆取石中的意义及可行性。方法对于术前患者有黄疸、胰腺炎病史,肝功能检查示直接胆红素升高或GPT、AKP升高,或保胆术中胆汁自胆囊管不能涌入胆囊,显示胆囊管流通不畅者等特殊病例,术前B超或CT、MRI检查无阳性结果43例,术中经胆囊管行胆管造影。结果内镜保胆取石术中43例行胆道造影,发现2例胆囊管结石,1例取出后保留胆囊,1例因结石取出困难,中转腹腔镜胆囊切除,7例发现胆总管结石,行腹腔镜胆总管切开胆道镜取石并置"T"管引流,术后6～8周经"T"管造影、胆道镜、超声检查显示胆道通畅无残余结石,拔除"T"管。2例十二指肠乳头轻度狭窄,未行特殊处理。结论合理选择和应用术中胆囊-胆管造影,能提供可靠、直观、清晰的图像,全面了解胆道走向,提高胆囊管、胆总管病变诊断的正确率,减少了不必要的胆道阴性探查,对于手术方式选择有指导意义。【Objectives】 To evaluate the significance and feasibility of selected intraoperative gallbladder cholangiography （IOC） during endoscopic invasive cholecystolithotomy with gallbladder preserved. 【Methods】 Intraoperative gallbladder -cholangiography was conducted in 43patients who were obstructive jaundice or pancrestatuitis, the level of TBIL, GPT or AKP was higher than normal, the bile cannot output from the cystic duct, the cystic duct was obstructed, or who had no positive results by B-mode Ultrasound, CT or MRI.【Results】All the 43 patients were treated with intraoperative gallbladder -cholangiography, and the success rate was 100% . The gallbladder bile duct stones were detected in 2 patients by IOC, one of the 2 patients preserved the gallbladder, one underwent the operation of laparoscopic cholecystectomy who cannot remove the stones. The common bile duct stones were detected in 7 by IOC, and they were converted to common bile ductexploration and T-tube drainage by open cholecystectomy. T type tube was removed after the operation for 6-8 weeks by the examination of giography, choledochoscope or B -mode Ultrasound. The SOD were detected in 2 patients by IOC, they gave no special treatment.【Conclusion】The intraoperative gallbladder-cholangiography can give reliable image, be of high clinical evaluation that debase the post operative complications and boost the quality in endoscopic invasive cholecystolithotomy with gallbladder preserved, can prevent residual tone after operation, avoid bile duct exploration or injury and make of abnormal bile duct, and can direct the choice of surgical approach.

关 键 词：胆囊-胆管造影 胆囊结石 微创保胆 

分 类 号：R657.4[医药卫生—外科学]