超细胆道镜在术中经胆囊管胆道探查的临床应用

目的探索胆道探查手术中应用超细胆道镜的临床价值。方法开腹或腹腔镜手术切除胆囊后保留残留胆囊管0．5～0．6cm，经胆道探条或血管分离钳机械扩张胆囊管，直至CHF—XP20超细纤维胆道镜随意插进胆总管，观察胆总管、肝总管及左右肝管，同时可以经胆道镜活检孔道插入配置的取石网篮取石，或插入配置的活检钳进行组织活检。结果332例胆总管内小结石（0．3～0．5cm），其中25例合并肝内一级胆管结石，术中经超细纤维胆道镜检查证实后，使用网篮顺利取出；9例胆总管内隆起样病变取组织活检，其中炎性息肉样病变5例，轻一中度不典型增生病变4例；胆总管下端炎性狭窄及乳头肌收缩功能减退24例。365例经胆囊管进行均顺利完成超细纤维胆道镜检查及治疗，术中未出现胆道持续出血、胆道穿孔及术后胆道感染等并发症。295例随访3～12个月（平均7．5月），未发现术后残余结石，继续随访13～18个月（平均15．5月），胆总管结石复发12例。结论超细纤维胆道镜经胆囊管进行胆道探查手术有严格适应征，合理、选择性的应用可避免总胆管切开。

Fibercholedochoscopy for Transcystic Common Bile Duct Exploration During Operation

Objective To explore the clinical value of fibercholedochoscope in transcystic common bile duct exploration during operation.Methods Approximately 0.5-0.6 cm segment of the cystic duct was preserved after traditional or laparoscopic cholecystectomy in 365 cases.A biliary tract probe or blood vessel forceps were used to dilate the cystic duct,and then a fibercholedochoscope(CHF-XP20) was placed into it to explore the common bile duct,common hepatic duct,and left and right hepatic ducts.Meanwhile,reticular basket or biopsy forceps were employed to remove calculi or obtain tissues for biopsy.Results Totally 332 cases of common bile duct stones were confirmed by fibercholedochoscopy(0.3-0.5 in diameter),among which 25 were complicated with calculi in the primary intrahepatic bile duct,9 were diagnosed with inflammatory polyp(5 cases) or mid-moderate atypical hyperplasia(4) by biopsy,and 24 were found as having inflammatory stenosis of the choledocha or dysfunction of the papillary muscle.The diagnosis and treatment by fibercholedochoscopy were completed in all the 365 cases.No one had continuous hemorrhage,or biliary perforation or infection during and after the operation.Follow-up was achieved for a mean of 7.4 months(3-12) in 295 patients;none of them had residual stones.The other patients were available for 13 to 18 months(mean 15.5),during which recurrent common bile duct stones were found in 12 cases.Conclusions Fibercholedochoscopy is feasible for transcystic common bile duct exploration in strictly selected patients.By using the method,choledocholithotomy can be avoided.