继发性胆总管结石的胆囊管局部解剖与经胆囊管探查胆道的可行性研究:附100例报告  

Anatomical Localization of the Gallbladder Duct and Feasibility Study on Bile Duct Exploration Through the Cyctic Duct for Secondary Choledocholithiasis:Report of 100 Cases

作　　者：陈德兴[1] 刘文超 朱修全 王婷婷 张俏[1] 张海铅 陈墨 Chen Dexing;Liu Wenchao;Zhu Xiuquan(Department of General Surgery,Jilin Province Qianwei Hospital,Changchun 130012,China;不详)

机构地区：[1]吉林省前卫医院普外一科,长春130012 [2]吉林省抚松县人民医院普外科,抚松134500

出　　处：《中国微创外科杂志》2025年第3期135-140,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胆囊管局部解剖特点和经胆囊管探查胆道取石、一期缝合术的可行性。方法2023年2~9月我科对100例继发性胆总管结石行腹腔镜下经胆囊管胆道探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE),术中对胆囊管汇入胆总管方位、胆囊管内径、胆囊管的切开长度、胆囊管与胆总管并行长度、切开的胆囊管或胆总管与十二脂肠上缘距离、胆道镜取石直径6项指标进行测量。结果胆囊管注入胆总管方位:9~12点92例,其中10、11点76例,占76%;1、2点各1例,占2%;7、8点分别为2、4例,占6%。胆囊管内径3~13 mm,中位数5.0 mm。切开胆总管长度:21例(占21%)切开胆总管,切开长度1~5 mm,中位数3.0 mm。胆囊管与胆总管并行长度:36例并行,并行长度2~40 mm,中位数10.0 mm。切开的胆囊管或胆总管距十二脂肠上缘距离5~20 mm,中位数15.0 mm。90例术中胆道镜取出结石,共取出结石128枚,结石直径1.5~22.0 mm,中位数5.0 mm。100例LTCBDE均获成功。术后3个月随访83例(占83%),出院后食欲恢复正常,恢复正常生活和工作,无腹痛、黄疸、发热等胆管结石症状发生,肝功能正常,B超示胆总管直径5~10 mm,中位数7 mm,无术后狭窄。结论经胆囊管探查胆总管可行,对胆总管无或较小的损伤,对Oddi括约肌无损伤,是继发性胆总管结石腹腔镜下胆道镜探查取石的最佳路径和术式。Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o’clock,of which 76 cases at 10 and 11 o’clock,accounting for 76%;1 case each at 1 and 2 o’clock,accounting for 2%;2 and 4 cases at 7 and 8 o’clock respectively,accounting for 6%.The inner diameter of the cystic duct ranged from 3 mm to 13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in 36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was 5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the 100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or

关 键 词：胆囊管 胆道探查术 继发性胆总管结石 腹腔镜下经胆囊管胆道探查取石 

分 类 号：R65[医药卫生—外科学]