腹腔镜胆囊切除术中选择性胆道造影的临床应用

目的:探讨降低腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆总管残留结石发生率的方法及术中胆道造影的价值。方法:对315例LC中经胆囊管胆道造影患者临床资料进行回顾性分析。结果:术中胆道造影全部成功,其中胆道正常276例,胆总管内结石27例,胆总管下端狭窄12例。结论:选择性术中胆道造影可避免不必要的胆道探查及胆总管结石残留。     

腹腔镜胆囊切除术中胆道造影的临床意义

目的:探讨术中胆道造影对行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)患者的临床意义。方法:回顾性分析113例因胆囊结石行LC加术中胆道造影患者的情况。结果:113例患者中造影成功110例(成功率97%),发现胆总管结石5例,占4.5%(5/110)。结论:LC加术中胆道造影有利于防止胆道残余结石,对正确判断胆道解剖关系,减少胆道损伤有重要的临床意义。LC加术中胆道造影可常规使用。     

腹腔镜下胆囊管嵌顿结石的处理

目的: 总结腹腔镜胆囊切除术(laporoscopic cholecystectomy,LC)中胆囊管结石嵌顿的处理经验.方法: 回顾分析2001年3月至2005年3月施行的LC临床资料,共1 180例,其中33例胆囊管结石嵌顿,行胆囊管切开取石,并选择性行术中胆道造影.结果:32例成功,其中包括1例术中胆道造影提示胆总管结石者,行腹腔镜下胆总管切开胆道镜下网篮取石术;1例因嵌顿结石紧靠胆总管取出困难而中转开腹.结论: 胆囊管结石嵌顿经适当处理均能在腹腔镜下完成胆囊切除术.如合并胆总管结石则可在腹腔镜下胆管切开胆道镜取石或中转开腹.     

腹腔镜胆囊切除术中经胆囊管胆道造影的价值

目的　探讨在腹腔镜胆囊切除术 (LC)中经胆囊管胆道造影的价值。方法　分析 5 1例因慢性胆囊炎胆囊结石、急性胆囊炎胆囊结石、胆囊息肉和胆源性胰腺炎行LC的患者 ,在术中经胆囊管插管行胆道造影的结果。结果　 5 1例中 ,插管成功 4 7例 ,成功率为 92 .2 % ,其中 4 6例显影满意 ,显影率为 97.9%。术中造影发现胆总管结石 3例 ,中转开腹行胆总管切开取石、T管引流术 ,发现胆囊管走行异常 2例 ,插管造影过程中发现胆囊管结石 4例 ,造影平均时间为 (16 .7± 2 .7)min。结论　LC术中胆道造影操作简便安全 ,显影清晰 ,成功率高 ,能发现胆总管结石、胆囊管结石及胆道解剖变异 ,可降低胆道残留结石和胆管损伤的发生率 ,并能及时发现胆道损伤 ,提高LC的质量和安全性     

选择性胆道造影在腹腔镜胆囊切除术中的应用体会

目的 评价选择性术中胆道造影在腹腔镜胆囊切除术中的应用价值。方法 腹腔镜胆囊切除术中经胆囊管插管行胆道造影共88例。结果 造影均成功。术中造影发现胆总管结石5例,无胆管损伤。结论 选择性术中胆道造影,对降低胆总管结石残留,避免胆管损伤,提高腹腔镜胆囊切除术的疗效有重要价值。     

选择性术中胆道造影在腹腔镜胆囊切除术中的价值

目的:探讨选择性术中胆道造影在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:回顾分析231例术前诊断为胆囊结石、胆囊息肉样病变的患者于LC术中经胆道造影发现胆道病变、变异的临床资料。结果:225例造影成功,成功率97.4%。术中胆道造影发现胆囊管残石3例,胆总管结石12例,胆管损伤4例,胰胆管汇合异常14例,胆囊管异常开口12例,右侧副肝管4例,胆总管憩室1例,十二指肠乳头旁憩室6例,Mirizzi综合征5例,右肝内钙化灶2例。结论:LC术中行胆道造影不仅能发现术前未确诊的胆总管结石、胆囊管结石,而且利于胆管变异、胰胆管汇合异常及乳头旁憩室的诊断。     

腹腔镜胆囊切除术中胆道造影的临床应用

回顾性分析436例腹腔镜胆囊切除术患者的临床资料,其中114例术中经胆囊管胆道造影,322例未行造影。114例行术中胆道造影者,术中发现胆总管结石9例(7.89%),胆管损伤1例(0.88%);术后随访3~6个月发现胆总管残余结石2例(1.75%)。322例未行术中胆道造影者,术中发现胆管损伤1例(0.31%);术后随访3~6个月发现胆总管残余结石19例(5.90%)。腹腔镜胆囊切除术中经胆囊胆道造影操作安全、无创,可提高胆总管结石诊断率,及时发现胆管损伤,降低胆总管残余结石发生率,避免不必要的胆道探查。     

胆道造影在腹腔镜胆囊切除术中的临床意义

目的 探讨术中胆道造影在腹腔镜胆囊切除术(LC)中的临床意义.方法 回顾性分析90例因胆囊结石行LC,术中行胆道造影患者的情况.结果 90例患者均成功造影,发现胆总管结石7例,占7.8% (7 /90),胆道损伤2例,占2.2% (2 /90).结论 LC术中胆道造影有利于防止胆道残余结石,对正确判断胆道解剖关系,减少胆道损伤有重要的临床意义.     

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。     

胆道镜在腹腔镜胆囊切除术中的应用

目的:探讨如何减少腹腔镜胆囊切除术（LC）后胆总管残留结石的方法。方法:对65例磁共振胰胆管显像（MRCP）阴性的腹腔镜胆囊切除术（LC）患者行术中胆道镜检。结果:发现胆总管下端结石9例，术中均行胆道镜一次取出结石、T管引流，效果满意。结论:MRCP检查阴性的患者常规行术中胆道镜检、T管引流，可避免LC术后胆总管残留结石。     

十二指肠镜、腹腔镜序贯治疗胆石症2 248例分析

目的探讨十二指肠镜、腹腔镜序贯性诊治胆石症的价值. 方法回顾性分析2000年1月～2004年12月采用十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症2 248例的临床资料. 结果确诊胆囊结石1 817例,胆囊结石合并胆总管结石431例.B超诊断为胆囊结石2 021例中,行术前ERCP 690例,发现胆总管结石213例;术中胆道造影(IOC)85例,发现胆总管结石10例;腹腔镜胆囊切除(LC)术后胆总管残余结石6例,并经EST治愈.B超诊断胆囊结石合并胆总管结石227例中,ERCP证实胆总管结石202例.行LC 1 817例,EST LC 395例,LBDE 36例(其中胆管一期缝合26例,T管引流10例).全组中转开腹28例(1.2%),并发症52例(2.3%). 结论十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症,体现了内镜、腔镜联合应用的优势,术后残余结石率低,微创治疗成功率高.     

选择性胆道造影在腹腔镜胆囊切除术中的应用

目的探讨腹腔镜胆囊切除术（laparoscopy cholecystectomy,LC）中开展选择性的胆道造影技术及其临床应用价值。方法对98例术中胆道造影患者的临床资料进行回顾性分析。结果同期LC 862例,术中胆道造影98例,造影成功90例,成功率为91.8%。术中发现胆管结石7例,胆管损伤1例,胆道解剖异常2例。结论选择性术中胆道造影操作简便安全,成功率高,显影清晰,可有效降低胆管结石的残余率和胆管损伤的发生率,避免不必要的胆道探查,提高LC手术的安全性。     

Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy

Background Intraoperative fluorocholangiography (IOC) has been the standard method for bile duct imaging during cholecystectomy. Laparoscopic ultrasound (LUS) has been evaluated as a possible alternative, but has been used less frequently. The authors examined the evolving use of these two methods to assess the relative utility of LUS as the primary method for routine bile duct imaging during laparoscopic cholecystectomy (LC). Methods This study analyzed a prospective database containing 423 consecutive cholecystectomies performed by one attending surgeon in an academic medical center between 1995 and 2005. Results Intraoperative bile duct imaging was performed in 371 (94%) of 396 LCs performed for cholelithiasis. As recorded, IOC was performed in 239 cases, LUS in 236 cases, and both in 104 cases. Choledocholithiasis was present in 50 patients (13%). Common bile duct stones (CBDS) were identified by LUS in 3% of the patients without preoperative indicators of CBDS, and in 10% of the patients with one or more indicators. As shown by the findings, LUS had a positive predictive value of 100%, a negative predictive value of 99.6%, a sensitivity of 92.3%, and a specificity of 100% for detecting CBDS. Also, LUS identified clinically significant bile duct anatomy in 6% of the patients. In 1995, LUS was used for 20% of cases, whereas by 2005, it was used for 97% of cases. Conversely, the use of IOC decreased from 93% to 23%. Conclusions With moderate experience, LUS can become the primary routine imaging method for evaluating the bile duct during LC. It is as reliable as IOC for detecting choledocholithiasis. In addition, LUS can locate the common bile duct during difficult dissections. On the basis of this experience, LUS is used currently in nearly all LCs and is the sole method for bile duct imaging in 75% of these cases. IOC is used as an adjunct to LUS when LUS imaging is inadequate, when stronger clinical indicators of choledocholithiasis are present, or when biliary anatomy remains uncertain.     

Clinical models are inaccurate in predicting bile duct stones in situ for patients with gallbladder

Background  The probability that a patient has common bile duct stones (CBDS) is a key factor in determining diagnostic and treatment strategies. This prospective cohort study evaluated the accuracy of clinical models in predicting CBDS for patients who will undergo cholecystectomy for lithiasis. Methods  From October 2005 until September 2006, 335 consecutive patients with symptoms of gallstone disease underwent cholecystectomy. Statistical analysis was performed on prospective patient data obtained at the time of first presentation to the hospital. Demonstrable CBDS at the time of endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC) was considered the gold standard for the presence of CBDS. Results  Common bile duct stones were demonstrated in 53 patients. For 35 patients, ERCP was performed, with successful stone clearance in 24 of 30 patients who had proven CBDS. In 29 patients, IOC showed CBDS, which were managed successfully via laparoscopic common bile duct exploration, with stone extraction at the time of cholecystectomy. Prospective validation of the existing model for CBDS resulted in a predictive accuracy rate of 73%. The new model showed a predictive accuracy rate of 79%. Conclusion  Clinical models are inaccurate in predicting CBDS in patients with cholelithiasis. Management strategies should be based on the local availability of therapeutic expertise.     

How reliable is intraoperative cholangiography as a method for detecting common bile duct stones?

Background  Although intraoperative cholangiography (IOC) is a widely used method for detecting common bile duct stones (CBDS), its accuracy has not been fully evaluated in large nonselected patient samples. The purpose of this study was to assess the sensitivity, specificity and predictive value of dynamic IOC regarding its ability to diagnose CBDS in a population-based setting, and to assess the morbidity associated with the investigation. Methods  All patients operated on for gallstone disease between 2003 and 2005 in the county of Uppsala in Sweden, a county with a population of 302,000 in December 2004, were registered prospectively. The outcome of cholangiography was validated against the postoperative clinical course. Results  1171 patients were registered, and among these IOC was performed in 1117 patients (95%). Common bile duct stones were found in 134 patients (11%). One perforation of the common bile duct caused by the IOC catheter was recorded. Sensitivity was 97%, specificity 99%, negative predictive value 99%, positive predictive value 95%, and overall accuracy 99%. In 7 of the 134 cases where IOC indicated CBDS, no stones could be verified on exploration. In 4 of the 979 cases where IOC was normal, the clinical course indicated overlooked CBDS. Conclusion  Intraoperative cholangiography is a safe and accurate method for detecting common bile duct stones.     

常规/选择性胆道造影在腹腔镜胆囊切除术中的应用研究

目的 探讨腹腔镜胆囊切除术中常规应用和选择性应用胆道造影的效果.方法 常规术中胆道造影组1 520例,选择性术中胆道造影组457例.采用自制造影器或输液针头完成术中造影,比较2组的造影时间、造影成功率、胆总管结石发现率、胆管解剖变异发现率、医源性胆管损伤发生率、中转开腹率以及术后住院时间.结果 2组病例在造影时间、造影成功率、中转开腹率以及术后住院时间方面的差异均无统计学意义(P＞0.05);选择性造影组的胆总管结石发现率、胆管解剖变异发现率以及医源性胆管损伤发生率均高于常规造影组(28.25％比13.43％,10.71％比7.43％,2.05％比1.02％,P＜0.05).结论 在开展腹腔镜胆囊切除术的早期,应采用常规术中胆道造影,以避免医源性胆管损伤的发生和胆总管结石残留.待技术纯熟以后,可以选择性地进行术中胆道造影.     

Evaluation of perioperative cholangiography in one thousand laparoscopic cholecystectomies

We analyzed a teaching institution's experience with intra-operative cholangiography (IOCG) and endoscopic retrograde cholangiopancreatography (ERCP) and established an algorithm for their timing and use. The records of all patients undergoing LC during a five year period were reviewed. Patients with a history of jaundice or pancreatitis, abnormal bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase, or radiographic evidence suggestive of choledocholithiasis were considered "at risk" for common bile duct stones (CBDS). The remaining patients were considered to be at low "risk." LC was attempted on 1002 patients during the study period and successfully completed on 941 (94% of the time). The major complication rate was 3.1% and the common bile duct injury rate 0.1%. Eighty eight (9.5%) patients underwent ERCP, 67 in the preoperative period and 19 in the postoperative period. IOCG was attempted in 272 (24%) patients and completed in 234 for a success rate of 86%. Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were equivalent in the detection of CBDSs Twelve of the 21 patients (57%) with IOCG positive for stones underwent successful laparoscopic clearance of the common duct, and did not require postop. ERCP. No patients were converted to an open procedure for common bile duct exploration. Because postoperative ERCP was 100% successful in clearing the common duct, reoperation for retained common bile duct stones was not necessary. IOCG is an alternative procedure to ERCP for patients at risk with biochemical, radiological, or clinical evidence of choledocholithiasis. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. Preoperative ERCP is recommended in cases of cholangitis unresponsive to antibiotics, suspicion of carcinoma, and biliary pancreatitis unresponsive to supportive care. Although IOCG leads to a similar percentage of nontherapeutic studies as preoperative ERCP, it often allows for one procedure therapy.     

腹腔镜术中连续胆道造影258例分析

目的 :探讨腹腔镜术中连续胆道造影诊断胆道外科疾病的价值。方法 :对行腹腔镜胆囊切除(LC)、胆道探查 (LCHT)经胆囊、胆囊管、胆总管灌注连续胆道造影并与术前BUS结果进行对照。结果 :胆囊管结石 2 3例均于术中造影证实。胆总管病变 4 2例 ,术中造影确诊 2 9例 ,支持B超诊断 13例 ,B超确诊 12例 ;怀疑胆道结石 3例中 2例排除 ;胆总管肿瘤 4例中 2例经术中造影排除 ;右肝管结石 2例 ,右肝管损伤 1例均排除。结论 :腹腔镜术中连续胆道造影能清晰显示胆道病变 ,防止腹腔镜术中遗漏胆道病变与意外损伤 ,费用低廉 ,易操作 ,无并发症发生     

腹腔镜胆管造影在胆总管结石误探与漏探中的应用价值

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...     

Laparoscopic endobiliary stenting: a simplified approach to the management of occult common bile duct stones

Three years ago we described laparoscopic placement of biliary stems as an adjunct to laparoscopic common bile duct exploration (LCBDE) in 16 patients. We now present a modification of our technique and experience with 48 additional patients. Laparoscopic cholecystectomy with intraoperative fluorocholangiography (LC/IOC) performed in 372 consecutive patients during a 36-month period revealed common bile duct stones (CBDS) in 48 patients (12.9%). In this series, LCBDE was not performed and no attempt was made to clear CBDS prior to transcystic stent placement. Stent placement added 9 to 26 minutes of operative time to LC/IOC alone. Forty-four patients (92%) were discharged after surgery and four (8%) were observed overnight. Outpatient endoscopic retrograde cholangiopancreatography 1 to 4 weeks later succeeded in clearing CBDS in all patients. All stents were retrieved without difficulty and 3- to 36-month follow-up demonstrates no surgical, endoscopic, or stent-related complications to date. Laparoscopic biliary stent placement for the treatment of CBDS is a safe, rapid, technically less challenging alternative to existing methods of LCBDE. It preserves the benefits of minimally invasive surgery for patients, and virtually assures success of postoperative endoscopic retrograde cholangiopancreatography with complete stone clearance. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 2l–24, 2000 (poster presentation).