胆总管汇合部微切开探查取石术的优越性

目的：探讨汇合部胆道微切开取石术治疗胆管结石的优越性，并进一步明确胆道取石中放置T管的适用范围。 方法：针对85例实施胆道微切开手术的患者，运用MRCP（磁共振胰胆管造影）、Advantage Workstation AW4.2-07sdc软件、术中胆道镜成像系统、图画等方法，对胆道微切开取石的适用范围进行了系统性地讨论。 结果：绝大多数胆管结石患者的胆总管宽度在8 mm以上，而胆管的宽度可能与结石的大小和多少相关。胆管宽度≥11 mm（16例）的MRCP 结石影像面积（mm2）较胆管宽度＜11 mm（14例）的MRCP 结石影像面积显著性增大（148±67 vs 47±31，P 〈 0.05）。对于胆总管下段非游离、多发、结构致密结石，由于一次性彻底取石困难，需留置T管引流备二次胆道镜检查。 结论：胆道微切开取石技术可避免大多数不必要的术后T管处理，尤其适合于早期诊断的胆管结石。T管引流多仅限于一次性彻底取石困难、病情复杂的患者。

Superiority of mini-incision technique in bile-duct stone removal surgery

Objective：To discuss the superiority of bile duct mini-incision（BDM） technique during stone removal surgery in choledocholithiasis, and to further clarify the indications of T-tube insertion during the surgery. Methods：A total of 85 BDM operations were performed. Magnetic resonance cholangiopancreatography（MRCP）, Advantage Workstation AW4.2-07sdc software, choledochoscope imaging system, and illustrations were used to clarify the indications of BDM technique in stone removal procedure. Results：The width of common bile duct （CBD） was usually more than 8mm in our choledocholithiasis cases, and the width was probably related to the number and size of the stones. In the cases with CBD width over 11 mm （16 cases）, the MRCP stone imaging area （MRCP-SIA, mm2） was significantly larger compared with that （148±67 vs 47±31,P 〈 0.05） in the cases （14 cases） with CBD width less than 11 mm. T-tube insertion for secondary choledochoscope exam should be performed, if the stones were non-drift, multiple, and closely attached to the lower part of CBD with a difficultly complete stone removal. Conclusions：Most unnecessary T-tube insertions can be avoided by the BDM technique, especially suitable to the choledocholithiasis cases with early diagnosis. T-tube insertion is only performed in the difficultly complete stone removal and other complex cases.