术中胆道造影在腹腔镜手术治疗胆囊管结石中的应用  

Application of intraoperative cholangiograhy to laparoscopic surgery for calculus of cystic duct

作　　者：邓小明[1] 陈焱[1] 孙海[1] 张丰深[1] 吴国栋 李志强[1] 陈宇欣[1] 

机构地区：[1]解放军324医院肝胆外科,重庆400020

出　　处：《西南国防医药》2013年第5期488-490,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨术中胆道造影在腹腔镜手术治疗胆囊管结石中的应用。方法对74例胆囊管结石行腹腔镜胆囊切除同时术中胆道造影的临床资料进行回顾性分析。结果 68例完成腹腔镜手术,6例中转开腹;72例造影成功,成功率为97.3%;造影前行胆道冲洗14例,造影发现胆囊管残石2例,Mirizzi综合征5例,胆总管结石6例,造影后留置造影管减压4例。术中发现胆总管侧壁撕裂伤1例,造影提示胆总管-门静脉瘘1例。并发胆总管撕裂伤和胆总管-门静脉瘘各1例。结论腹腔镜手术治疗胆囊管结石过程中,胆道造影有助于了解胆囊管的走向和残端长度,明确Mirizzi综合征或胆总管结石的诊断,术中可经造影管冲洗胆道,术后留置造影管行胆道减压或为二期取石ERCP插管提供引导。Objective To investigate the application of intraoperative cholangiograhy（IOC） to laparoscopic surgery for calculus of cystic duct. Methods A retrospective analysis was made in the clinical data of 74 patients with calculus of cystic duct who received laparoscopic cholecystectomy（LC） and IOC. Results Sixty eight cases underwent LC successfully, and 6 ones got conversion to the open surgery. Visualization was successfully completed in 72 cases, and the success rate was 97.3%. Biliary tract was flushed in 14 cases before IOC. Stones remained in cystic duct were found in 2 cases. There were 5 cases of Mirizzi syndrome, 6 cases of choledocholithiasis. Biliary tract was decompressed by imaging tube in 4 cases after the visualization. During the operation, lateral wall avulsion of common bile duct was observed in one case. The visualization indicated and common bile duct-portal vein fistula occurred in one case. Conclusion During the procedure of laparoscopic operation for calculus of cystic duct, IOC helps to discover the trend of cystic duct and the length of the remnant duct and identify the diagnosed of Mirizzi syndrome and choledocholithiasis. Biliary tract can be flushed via the visualization tube during the operation. After the operation, the detainment of the imaging tube for the decompression of the biliary tract may provide guidance for ERCP intubation in stageⅡstone removal.

关 键 词：胆囊管结石 腹腔镜胆囊切除术 术中胆道造影 

分 类 号：R657.4[医药卫生—外科学]