腹腔镜胆囊切除术中经胆囊管胆道造影52例临床分析

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中选择性经胆囊管胆道造影的应用价值。方法回顾性分析52例LC中经胆囊管胆道造影者的临床资料。结果除1例患者因胆囊管过细,过短及急性胆囊炎致Calot三角粘连、解剖不清而致插管失败外,余51例(98.1%)均插管成功。术中胆道造影发现胆总管结石4例,其中3例术中经纤维胆道镜取石成功,1例因结石嵌顿中转开腹行胆总管切开取石;胆囊管过长或变异3例,在造影片指导下成功完成LC;胆道损伤2例,转开腹行胆总管修补,T管引流术后痊愈出院,术后随访未见明显手术相关并发症。结论 LC术中选择性经胆囊管胆道造影简单易行,能显著降低胆道结石残留和及时发现胆道损伤等严重并发症,值得推广应用。

Clinical Analysis of 52 Cases of Intraoperative Cholangiography during Laparoscopic Cholecystectomy

Objective To discuss the value of intraoperative selective cholangiography during laparoscopic cholecystectomy（LC）.Method Retrospective analysis was made on the clinical data of 52 patients undergoing intraoperative cholangiography during LC from January 2005 to January 2010.Results One patient failed in intubation.And in the 51 cases,according to the intraoperative cholangiography,4 cases of common bile duct stone were found,3 had cystic duct excess or variation,2 had bile duct injury.And all the patients were treated accordingly.Conclusion The intraoperative cholangiography during LC is easy to perform,which can help to promptly detect bile duct injury,and to markedly reduce the incidence of residual bile stones and other serious complications.