腹腔镜胆囊切除术中胆道造影的应用价值

目的 评价术中胆道造影技术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1226例,其中1180例造影成功,成功率为95．5％。结果 术中造影共发现胆总管结石78例,胆管损伤7例,副肝管2例。结论 腹腔镜胆囊切除术中胆道造影简单易行,显影清楚,能提高手术质量,降低胆管损伤发生率。     

术中胆道造影在腹腔镜胆囊切除术中的应用

2001年9月～2005年3月，我院行术中胆道造影（intraoperative cholangiography，IOC）86例，采用尼龙注射针头穿刺胆囊管，造影成功84例，成功率97.7％，术中发现胆总管结石3例，胆管变异2例，胆管损伤1例。我们认为IOC操作简单、安全、迅速，显影清晰，能降低胆道损伤的发生率，发现胆总管残石，提高腹腔镜胆囊切除术的质量。     

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。     

腹腔镜胆囊切除术中胆道造影的价值

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）术中胆道造影的临床价值及适应证。方法2003年1月-2006年1月我院对165例行LC术中经胆囊管胆道造影（intraoperative cholangiography，IOC），根据造影结果指导LC术中操作，调整手术方案。结果165例LC术中经胆囊管胆道造影发现胆囊管变异22例，胆囊管结石12例，合并胆总管结石8例。本组无胆道损伤，避免胆总管阴性探查7例。结论LC术中经胆囊管胆道造影对于预防术中胆道损伤、减少胆总管阴性探查具有重要价值。     

术中胆道造影在腹腔镜胆囊切除术中的应用价值

目的 评价术中胆道造影技术在腹腔镜胆囊切除术中的应用价值。方法 腹腔镜胆囊荨除术中经胆囊管插管行胆道造影共１４６６例,１３８２例造影成功,成功率为９４．２７％。结果 术中造影发现胆总管结石９２例,胆管损伤８例,副肝管１例。结论术中造影操作迅速,安全,显影清晰成功率高,能降低胆管损伤发生率;提高腹腔胆囊切除术的质量,值得推广应用。     

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选择性胆道造影的手术配合

在腹腔镜胆囊切除术 (ＬＣ)中行选择性胆道造影 ,对及时发现术中的胆管损伤 ,减少胆总管残留结石的发生率有十分重要的意义。我院 2 0 0 0年 1月至 2 0 0 2年 5月共开展ＬＣ手术 6 0 0余例 ,行术中选择性胆道造影 6 0例 ,现报告如下。1　临床资料本组结石性胆囊炎 6 0例中女 2 4例 ,男 36例 ,18～ 83岁 ,平均 4 7岁。其中 2 3例术前Ｂ超检查胆总管内未发现结石 ,但胆总管直径 >0 7ｃｍ ;18例术中发现胆囊内为细小结石 ,胆囊管直径 >0 4ｃｍ ;13例术中见胆总管增粗 ,直径约 1 0ｃｍ。 6例因胆囊三角区解剖不清 ,看不清胆总管。均于ＬＣ术中…     

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.     

Intraoperative cholangiography during laparoscopic cholecystectomy

BACKGROUND: The routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy remains controversial. METHODS: A retrospective review of 950 consecutive laparoscopic cholecystectomies performed during an 8-year period was performed. For the first 2 years, IOC was performed selectively, and thereafter routinely. RESULTS: Attempted in 896 patients, IOC was successful in 734 (82%). Bile duct stones were found in 77 patients (10%), dilated ducts without stones in 47 patients (6%), and anatomic variations in 4 patients (0.5%). There were four (0.4%) minor intraoperative complications related to the IOC, with no consequences for the patients. There were three (0.3%) minor injuries of the bile duct, which were identified with IOC and repaired at the time of cholecystectomy without any consequences for the patients. In two of these patients, the structure recognized and catheterized as the cystic duct was revealed by IOC to be the bile duct. Thus IOC prevented extension to a major common bile duct (CBD) injury. CONCLUSIONS: Findings show that IOC is a safe technique. Its routine use during laparoscopic cholecystectomy may not prevent bile duct injuries, but it minimizes the extent of the injury so that it can be repaired easily without any consequences for the patient. The prevention of a major bile duct injury makes IOC cost effective.     

Intraoperative cholangiography during laparoscopic cholecystectomy

An audit of routine intraoperative cholangiography in a consecutive series of 496 patients undergoing laparoscopic cholecystectomy has been performed. Cannulation of the cystic duct was possible in 483 patients (97%). The use of portable, digitized C-arm fluorocholangiography was vastly superior to the employment of a mobile x-ray machine and static films in terms of reduced time to carry out the procedure and total abolition of unsatisfactory radiological exposure of the biliary tract. Repeat of the procedure was necessary in 22% of cases when the mobile x-ray equipment was used. Aside from the detection of unsuspected stones in 18 patients (3.9%), routine intra-operative cholangiography identified four patients (0.8%) whose management would undoubtedly have been disadvantaged if intraoperative cholangiography had not been performed.     

Cystic duct cholangiography during laparoscopic cholecystectomy

At present, there is no consensus regarding the routine use of intraoperative cholangiography during cholecystectomy. We describe a reliable technique for performing cystic duct cholangiography during laparoscopic cholecystectomy. Using this technique, we were able to cannulate the cystic duct in 97% of patients, completely visualize the biliary tree and duodenum in 93% of patients, and identify unsuspected choledocholithiasis in 3% of patients. Treatment options for the management of choledocholithiasis demonstrated by cholangiograms during laparoscopic cholecystectomy include conversion to an open cholecystectomy and common duct exploration, or endoscopic sphincterotomy and common duct stone extraction following laparoscopic cholecystectomy.     

Peroperative cholangiography during laparoscopic cholecystectomy]

The aim of this study was to assess the ease and the success of a laparoscopic technique of cholangiography. Following an initial period of training to gain expertise in laparoscopic surgery, 70 patients were included in the study. Six of them had a history of suggestive choledocholithiasis. Intraoperative cholangiography was performed using an angled catheter (Judkins) and a specific tubular cannula (Olsen, Storz) designed to guide and maintain the catheter in the cystic duct. Catheterization of the cystic duct and cholangiography were achieved in 61 patients. In 3 cases, stones were found in the common bile duct. The mean duration of the examination was 11 minutes (6.21). Cholecystectomy was performed after cholangiography. No biliary injuries were observed. These results show that intraoperative laparoscopic cholangiography is easy and not time-consuming. It obviates the need for preoperative investigations looking for biliary stones and provides an excellent definition of the biliary anatomy for safety purposes.     

Percutaneous transcholecystic cholangiography during laparoscopic cholecystectomy.

BACKGROUND: Controversy still exists regarding the role of routine cholangiography in laparoscopic cholecystectomy. Although the need to identify common bile duct stones is perhaps less critical than it was in the past, confirmation of anatomy by peroperative cholangiography is important for both clinical and medico-legal purposes. Conventionally, contrast has been introduced into the biliary tree via the cystic duct after dissection of Calot's triangle. METHODS: A simple technique of cholangiography by direct gall-bladder puncture is described, which can be done quickly and easily at the beginning of the operation. RESULTS: The retrospective analysis of 250 consecutive cases shows the technique to be safe, accurate and to provide useful cholangiograms in 85% of cases. CONCLUSIONS: Percutaneous transcholecystic cholangiography can be performed readily without special equipment. It provides valuable anatomical information in 85% of cases before commencing dissection of the cystic duct.     

The importance of intraoperative cholangiography during laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC.