腹腔镜胆管造影在胆总管结石误探与漏探中的应用价值  

Application value of laparoscopic cholangiography in misdiagnosis and missed detection of common bile duct stones

作　　者：黄龙 罗云 朱长康[1] 周良弼[1] 吴定泉[1] HUANG Long;LUO Yun;ZHU Chang-kang;ZHOU Liang-bi;WU Dingquan(The First Department of Surgery,Beibei Traditional Chinese Medical Hospital Affiliated to Guangzhou University of Chinese Medicine,Chongqing 400711,China)

机构地区：[1]广州中医药大学附属北碚中医院外一科,重庆400711

出　　处：《肝胆胰外科杂志》2021年第1期39-43,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：广州中医药大学附属北碚中医院院级课题(2020-01)。

摘　　要：目的为避免胆总管结石误探和漏探,分析腹腔镜胆管造影在胆管探查中的应用价值。方法回顾性分析2015年1月至2019年12月完成的230例腹腔镜胆囊切除(LC)、胆总管探查术(LCBDE)患者的临床资料,选取腹腔镜术中胆管造影(intraoperative cholangiography,IOC)的患者41例作为观察组,未进行IOC的患者189例作为对照组。结果观察组胆总管误探(阴性探查)1例,LC术后胆管残留结石0例(漏探0例)。对照组胆总管误探19例,其中12例胆总管探查无结石,7例因胆管损伤行了胆总管探查术;LC术后胆管残留结石6例(漏探6例)。观察组的胆总管误探率及漏探率明显低于对照组,差异均有统计学意义(P<0.05)。结论腹腔镜IOC不仅能弥补术前影像学检查及术中判断的不足,降低胆总管误探及漏探的发生率,还可发现胆管解剖变异,及时避免或发现胆管损伤,降低手术并发症。Objective To avoid the misdiagnosis and missed detection of common bile duct stones,the application value of laparoscopic cholangiography in bile duct exploration was analyzed.Methods The clinical data of 230 patients with laparoscopic cholecystectomy(LC)and common bile duct exploration(LCBDE)between Jan.2015 and Dec.2019 were retrospectively analyzed.41 patients with intraoperative cholangiography(IOC)were selected as the observation group,and 189 patients without IOC were selected as the control group.Results In the observation group,there was 1 case of common bile duct false exploration(negative exploration),0 case of residual bile duct stones after LC(0 case of missed exploration);in the control group,there were 19 cases of common bile duct false exploration,of which 12 cases had no stones during common bile duct exploration,7 cases had common bile duct exploration due to bile duct injury;6 cases had residual bile duct stones after LC(6 cases of missed exploration).The difference was statistically significant(P<0.05).Conclusion Laparoscopic IOC can not only make up for the lack of preoperative imaging examination and intraoperative judgment,reduce the incidence of false detection and missed detection of common bile duct,but can also find the anatomical variation of bile duct,avoid or find bile duct injury in time,and reduce surgical complications.

关 键 词：腹腔镜胆管造影 胆总管结石 胆总管结石误探和漏探 

分 类 号：R657.4[医药卫生—外科学] R814.43[医药卫生—影像医学与核医学]