腹腔镜胆囊切除术中胆道造影的临床应用

目的 探讨选择性术中胆道造影在腹腔镜胆囊切除术中的临床应用价值。方法 回顾性分析125例经腹腔镜胆囊切除术中选择性经胆囊管插管行胆道造影的临床资料。结果 术中造影发现胆总管结石22例,胆总管下端狭窄4例,胆管损伤1例,副肝管2例。结论 腹腔镜胆囊切除术中选择性经胆囊管行胆道造影对降低胆管结石的残留,减少不必要的胆管阴性探查,辨明胆道解剖,避免及发现胆管损伤,提高腹腔镜胆囊切除术的质量和安全性有重要价值。     

腹腔镜胆囊切除术中经胆囊管胆道造影的临床意义

目的 探讨腹腔镜胆囊切除术中行经胆囊管胆道造影对隐匿性胆总管结石及医源性胆管损伤诊断的临床意义.方法 回顾性分析341例腹腔镜胆囊切除术患者的临床资料,其中137例术中行经胆囊管胆道造影,207例未行造影.结果 137例行术中胆道造影者,术中发现胆总管结石11例（8.03％）,胆管损伤1例（0.72％）;术后随访3～6个月发现胆总管残余结石4例（2.92％）,未发现胆管损伤.204例未行术中胆道造影者,术中发现胆总管结石5例（2.45％）,术中未发现胆管损伤;术后随访3～6个月发现胆总管残余结石18例（8.82％）,胆管损伤2例（0.98％）.结论 腹腔镜胆囊切除术中经胆囊管胆道造影操作安全、快速、无创,可提高胆总管结石诊断的敏感度,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.     

术中胆道造影在急诊腹腔镜胆囊切除术中的应用价值

目的 探讨经胆囊管术中胆道造影在急诊腹腔镜胆囊切除术中的价值.方法 对95例急性胆囊炎胆囊结石患者行急诊腹腔镜胆囊切除术,术中行经胆囊管胆道造影,对胆总管结石、胆囊管结石的发生率及发现胆管误伤和解剖变异情况进行回顾性分析.结果 经术中胆道造影发现胆总管结石11例、胆囊管结石6例、迷走胆管1例、肝总管损伤1例、Mirizzi综合征2例、胆道变异2例.结论 经胆囊管术中胆道造影在急诊腹腔镜胆囊切除术中可发现术前未发现的胆总管、胆囊管结石,指导治疗,减少术中胆管损伤,及时发现胆管损伤并正确处理,减轻急性炎症带来的手术困难.     

选择性经胆囊管造影在腹腔镜胆囊切除术中的临床应用

目的探讨选择性经胆囊管造影在腹腔镜胆囊切除术中的临床应用价值。方法选取2018年1月至2019年9月在腹腔镜胆囊切除术中行选择性经胆囊管造影的40例患者资料进行回顾性分析。结果腹腔镜胆囊切除术中选择性经胆囊管造影成功38例,成功率95.00%,经造影发现胆总管结石8例,胆囊管结石2例,胆管变异1例,胆管损伤1例。结论临床在腹腔镜胆囊切除术中行选择性经胆囊管造影能够有效发现胆总管结石情况并及时摘除,避免胆道阴性探查,及时发现胆道变异、胆管损伤,提高腹腔镜胆囊切除术治疗效果,增强手术安全性。     

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。     

经胆囊管造影在腹腔镜胆囊切除术中的应用

经胆囊管造影在腹腔镜胆囊切除术中的价值。对80例腹腔镜胆囊切除术中常规经胆囊管造影胆管结石的发生率回顾分析。经术中胆囊管造影80例,阳性9例有胆总管探查指征。经腹腔镜胆囊切除术中胆囊管造影可发现术前难以发现的胆总管结石,对降低胆总管探查阴性率有较大的临床价值,可克服腹腔镜胆囊切除术的局限,减少胆管损伤。     

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。     

LC中选择性行经胆囊管造影的临床应用

目的评价选择性行经胆囊管胆道造影在腹腔镜胆囊切除（LC）术中的应用价值。方法回顾性分析113例在LC术中选择性行经胆囊管造影的患者的临床资料。结果术中造影成功108例,成功率为95．6％,术中发现胆总管结石16例,胆管变异3例,胆管损伤1例。结论在LC术中行选择性经胆囊管造影,可协助确诊胆道结石残留,避免不必要的胆道阴性探查,并可避免和发现胆管损伤,对于提高腹腔镜胆囊切除术的质量和安全性具有重要临床价值。     

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。     

腹腔镜胆囊切除术中胆管造影的临床应用价值

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中胆管造影的临床应用价值.方法：回顾分析2001年4月至2006年12月在腹腔镜胆囊切除术中经胆囊管插管行胆管造影96例患者的临床资料.结果：造影成功93例,成功率96.9%,术中发现胆总管结石5例,胆管变异4例,胆总管损伤1例.结论：LC术中胆管造影可防止术后胆管残石的发生,避免不必要的胆管探查,明确胆管解剖及变异,预防并及时发现胆管损伤,降低了并发症,提高了质量,有较高的临床应用价值.     

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。     

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.     

腹腔镜下经胆囊管造影网篮胆总管结石取出术

目的探讨腹腔镜胆囊切除时经胆囊管取出胆总管结石的可行性. 方法回顾性分析2003年1月～2004年7月经胆囊管胆道造影18例的临床资料.腹腔镜下切除胆囊之前切开胆囊管,插入造影管行胆道造影,发现胆总管结石后,经胆囊管插入金属网篮,取出胆总管结石. 结果经胆囊管行胆总管造影18例,发现胆总管结石11例,其中2例因结石明显大于胆囊管直径,2例因导管无法经胆囊管进入胆总管,1例因结石嵌顿于壶腹部套篮无法套取结石而放弃腹腔镜下经胆囊管胆总管结石取出,余6例成功完成腹腔镜下经胆囊管胆总管结石取出术.6例随访6～18个月,B超检查未发现胆总管结石残留,无胆总管狭窄或扩张. 结论腹腔镜下经胆囊管胆总管结石取出术可作为部分继发性胆总管结石的术中诊断和治疗手段.     

术中胆道造影在腹腔镜胆囊切除术中应用价值

目的探讨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在切除胆囊前,常规在C型臂X线下行胆道造影,并及时采集、保存图像,以了解肝外胆管内有无结石存在。若发现结石,继而行中转开腹胆总管探查取石术。结果施行的76例术中胆道造影中,发现胆总管结石5例,其中胆总管下段多发结石2例,胆总管内单发结石2例,胆总管内一长柱状结石1例。5例胆总管结石取出术后均放置T型管,随访T管造影复查,未见结石残留。结论腹腔镜胆囊切除术常规行术中胆道造影可有效地防止胆道结石残留,避免了不必要的胆管探查,减少了胆管损伤和术后并发症的发生,减少了患者的住院费用和住院时间,且术中胆道造影操作简单、迅速、安全,除有禁忌证外,应常规应用术中胆道造影。     

Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones

BACKGROUND: The need for cholangiography to identify possible bile duct stones in all patients undergoing cholecystectomy is controversial. AIMS: To assess the results of a policy for selective pre-operative endoscopic retrograde cholangiography (ERC) in patients undergoing laparoscopic cholecystectomy and to determine the incidence of postoperative symptomatic bile duct stones. PATIENTS AND METHODS: Between 1993 and 1998, 600 patients underwent laparoscopic cholecystectomy under one consultant surgeon. Patients were selected for pre-operative or postoperative ERC based on symptoms, liver function tests and/or abnormalities on ultrasonography. A general practitioner questionnaire was used to assess follow-up of patients with postoperative stones. RESULTS: Of 600 patients, 107 (18%) with a median age of 57 years and male:female ratio of 1:2.1 were selected to undergo pre-operative ERC; of these, 41 patients (38%) had bile duct stones. Postoperative ERC was performed in 30 patients (5%) and stones were identified in seven (23.3%). Three patients (0.5%) had stones removed within 15 days of operation and four (0.7%) between 2.6 months and 1.8 years. Median follow-up was 5.0 years (range, 2.5-7.5 years). The overall incidence of bile duct stones was 48 cases (8%). The stone rate was 11% in males and 7.3% in females. Stones were successfully extracted at ERC in 43 patients (89.6%). CONCLUSIONS: A policy of selective pre-operative ERC is the most effective technique for identifying and removing bile duct stones and the incidence of symptomatic gallstones following laparoscopic cholecystectomy is very low. With an overall stone rate of 8%, routine peroperative cholangiography is unnecessary and, in a surgical unit providing an ERC service, laparoscopic exploration of the bile duct is not a technique required for the management of bile duct stones.     

Preoperative Endoscopic Sphincterotomy and Laparoscopic Cholecystectomy for the Management of Cholecystocholedocholithiasis: 10-Year Experience

Abstract No procedure has yet been identified as the “gold standard” for the detection and treatment of common bile duct stones (CBDS) in patients undergoing laparoscopic cholecystectomy (LC). This prospective study involves 2137 patients undergoing elective laparoscopic cholecystectomy. The algorithm for diagnostic management in place until July 1997 involved routine intravenous cholangiography and selective endoscopic retrograde cholangiography (ERC). Subsequently, assessment of the bile duct was not routinely performed, but a scoring system was applied to single out those patients at risk of CBDS who should undergo intravenous cholangiography and/or ERC (see Fig. 2). Whenever bile duct stones were found, endoscopic sphincterotomy (ES) was performed, and LC was performed with a standardized four-cannula technique after endoscopic bile duct stone clearance. Common bile duct stones were suspected in 340 patients who were referred for preoperative ERC; 250 patients were referred for ES; 21 patients were referred for open surgery because of failure of ERC or sphincterotomy. Common bile duct stones, detected in 283 cases (13.2%), were removed before surgery in 250 cases (88.3%) and during surgery in 28 cases (9.9%). Self-limited pancreatitis occurred in 4.2% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.4% of the cases. The conversion rate was 8.3% if sphincterotomy had been performed previously and 3.4% after standard laparoscopic cholecystectomy (p < 0.001). The morbidity rate was 4.5%; mortality, 0.09%. During follow-up five patients (0.2%) had retained stones endoscopically treated. Future trials of novel strategies for detecting and treating CBDS should compare the results of novel strategies with those of the strategy employed in this study, which includes selective ERC, preoperative ES, and LC.     

C型臂X线机下动态术中胆道造影在胆囊切除术中的应用

目的 探讨C型臂X线机下动态术中胆道造影在胆囊切除术中的应用价值.方法 对2006-2010年我科利用C型臂X线机对126例开腹胆囊切除术病例行动态术中胆道造影的资料进行回顾性分析.结果 造影成功122例,成功率96.8%.造影发现结石11例,其中胆总管结石8例,左肝管结石1例,右肝管结石2例,均行胆总管切开,胆道镜下取石,T管引流术.胆管损伤1例,行胆管修补.副肝管1例,Mirizzi综合征1例.均采取相应方法予以正确处理,一期愈合出院.全组无假阳性发生.平均耗时6.25min.结论 C型臂X线机下动态术中胆道造影法在胆囊切除术中是一种有效方法,省时,省力,显影清楚,值得推广.     

腹腔镜术中胆道造影398例分析

目的探讨腹腔镜术中胆道造影对腹腔镜胆囊切除术的应用价值。方法回顾性分析近8年间398例腹腔镜术中胆道造影者的临床资料。结果发现胆总管结石40例，胆囊管内结石3例，胆道畸形54例，胆道损伤6例。均予相应治疗，无死亡。结论腹腔镜术中胆道造影的临床应用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。     

"Sequential" treatment: is it the best alternative in cholecysto-choledochal lithiasis?

Laparoscopic cholecystectomy has become the treatment of choice for patients with symptomatic cholelithiasis. About 10-20% of patients with gallbladder stones may also present associated common bile duct stones. The management of the latter remains controversial because many different surgical strategies are available: laparoscopic treatment (laparoscopic common bile duct exploration), sequential endoscopic and laparoscopic treatment (endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy [ERCP/ES] prior to laparoscopic cholecystectomy), inverted sequential endoscopic-laparoscopic treatment (laparoscopic cholecystectomy followed by ERCP/ES), and combined endoscopic-laparoscopic treatment (laparoscopic cholecystectomy with intraoperative ERCP/ES). The aim of this study was to evaluate the efficacy and safety of sequential endoscopic-laparoscopic treatment in patients with cholecystocholedocholithiasis. We retrospectively analyzed the clinical, biochemical and radiological features of 552 patients operated on for cholelithiasis from 1991 to 2001. Common bile duct stones were suspected on the basis of increased serum levels of bilirubin, GOT, GPT, GGT, alkaline phosphatase; presence of jaundice; history of pancreatitis or cholangitis; dilated common bile duct (diameter > 8 mm) or common bile duct stones at hepatobiliary ultrasonography; presence of common bile duct stones at MR-cholangiography or at i.v. cholangiography. In patients with suspected common bile duct stones, preoperative ERCP was performed; if common bile duct stones were confirmed, ES was performed. When common bile duct stones were not suspected preoperatively, laparoscopic cholecystectomy was performed directly. Overall morbidity, mortality and conversion rates in the two groups were evaluated. Of 552 patients admitted for cholelithiasis, 62 (11.3%) underwent preoperative ERCP for suspected common bile duct stones. In 41 patients (66.1%) common bile duct stones were identified and ES with common bile duct stone extraction was performed in 40 patients (clearance: 97.5%). The overall morbidity was 16% (10 cases of post-ERCP acute pancreatitis); no mortality occurred. The conversion rate during subsequent laparoscopic cholecystectomy was 4.8%. In the group of patients with no suspicion of common bile duct stones, the conversion rate was 4.9%. Sequential treatment cannot be considered the best approach for patients with cholecystocholedocholithiasis because of its morbidity rate and the high rate of negative preoperative ERCP findings. Combined endoscopic-laparoscopic treatment seems to present more advantages, especially in term of morbidity, hospital stay and patient compliance and may, in future, be considered the treatment of choice for patients with cholecystocholedocholithiasis.     

Common bile duct stones: the role of preoperative, intraoperative, and postoperative ERCP

The indications for endoscopic retrograde cholangiopancreatography (ERCP) to demonstrate the presence of common bile duct stones has changed in the era of laparoscopic cholecystectomy. Preoperative ERCP is indicated when there is strong evidence of common bile duct stones, ie, jaundice, cholangitis, ultrasound demonstration of a common bile duct stone, and specific enzyme elevations. Preoperative ERCP is not indicated in mild gallstone pancreatitis. ERCP and endoscopic sphincterotomy as the only treatment regimen is successful in elderly patients with severe comorbid illness who have gallstones and common bile duct stones. Intraoperative ERCP does not play a role in the era of laparoscopic cholecystectomy. Transcystic common duct stone removal or laparoscopic choledochotomy is becoming the approach to common duct stones demonstrated by intraoperative cholangiography. Postoperative ERCP is indicated when intraoperative removal of common bile duct stones is unsuccessful. It is important to note that magnetic resonance cholangiography will play an increasing role and will reduce the indications and frequency of the use of ERCP.