选择性术中胆道造影在腹腔镜胆囊切除术中的应用价值

我院1992年2月至2006年4月间为315例病人行腹腔镜胆囊切除术中胆管造影，有效的预防胆管结石的漏诊，提高胆道疾病的术中诊断率取得了良好的效果，现报道如下。     

腹腔镜胆囊切除术中胆道造影对患者肝功能影响的预防护理

目的探讨腹腔镜胆囊切除术中胆道造影对患者肝功能影响的预防护理措施及效果。方法对21例腹腔镜胆囊切除术中行胆道造影患者,术前认真筛选病例,积极做好术前检查及相关准备,术中准确配合,术后密切监护。结果患者均手术顺利,术后3d部分肝功能指标增高,但差异无统计学意义(均P0.05),术后7d基本恢复正常。结论腹腔镜术中胆道造影是一项安全、可靠的诊断技术,积极而适当的预防护理能减少对术后肝功能的影响,促进患者早日康复。     

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胆道造影对患者肝功能影响的预防护理

目的探讨腹腔镜胆囊切除术中胆道造影对患者肝功能影响的预防护理措施及效果。方法对21例腹腔镜胆囊切除术中行胆道造影患者,术前认真筛选病例,积极做好术前检查及相关准备,术中准确配合,术后密切监护。结果患者均手术顺利,术后3d部分肝功能指标增高,但差异无统计学意义（均P〉0.05）,术后7d基本恢复正常。结论腹腔镜术中胆道造影是一项安全、可靠的诊断技术,积极而适当的预防护理能减少对术后肝功能的影响,促进患者早日康复。     

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。     

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。     

选择性术中胆道造影的临床应用价值

目的 探讨选择性术中胆道造影在胆石症病人中的临床应用价值。方法 通过对75例术中胆道造影的胆石症病人和62例胆道但未行术中胆道造影的胆石症病人的对比研究。比较两组术后胆道残石的发生率。结果 发现在有胆道相对探查指征的病人经胆囊管造影的阴性率为64.7%，曾行术中造影的胆石症病人的术后残石率为2.0%，而未行术中造影的胆石症病人的残石率为15.5%。结论 选择性术中胆道造影可降低胆道阴性探查率，避免不必要的胆道探查，还可降低胆道残石发生率。     

胆道造影在手术中的应用及其价值

本文报告５６８例胆道疾患病人在手术中根据不同情况采取三种不同的方法行胆道造影，均获得成功。造影发现阳性结石病人１７３例，占３０．４５％。同时讨论了术中胆道造影在了解胆道系统解剖及预防术后残余结石，避免胆道损失，降低术后并发症，提高手术质量，使病人及早康复方面的临床价值。     

术中胆道造影联合胆道镜治疗胆石病的体会

目的探讨胆道手术中胆道造影及联合应用胆道镜治疗胆石病,以减少术后结石残留。方法回顾性分析我院2002年11月至2008年12月间50例胆道结石手术中胆道造影及联合应用胆道镜的资料。结果本组50例胆道结石手术均行术中胆道造影及联合应用胆道镜检查,术后胆道残余结石4例,残石率为8%。结论术中胆道造影及联合应用胆道镜可明显降低术后残石率,为防治胆道残余结石提供有效方法。     

800例术中胆道造影临床分析

作者对８００例胆囊结石具有相对胆总管探查指征的患者，采用三种不同方法行术中胆道造影。获得满意效果。造影发现阳性结石患者３００例，阳性率占３７．５％。通过临床资料的分析讨论，充分肯定了术中胆道造影对于直接了解胆道系统解剖及预防术后残余结石，避免胆道损伤，降低术后并发症，提高手术质量等方面的临床价值。同时提出了术中胆道造影的指征。     

Does routine intraoperative cholangiography prevent bile duct transection?

Background The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature.Methods Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed.Results The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection.Conclusions In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.     

Double cystic duct preoperatively diagnosed and successfully treated with laparoscopic cholecystectomy: A case report

IntroductionA single gallbladder with a double cystic duct is a very rare finding. In addition, few cases with this rare condition are preoperatively diagnosed. However, the preoperative confirmation or suspicion of this rare condition could facilitate safe laparoscopic cholecystectomy, which is a minimally invasive therapeutic modality for gallbladder disease. We herein present a case of gallstone disease in a patient with a double cystic duct who was preoperatively diagnosed and successfully treated with laparoscopic cholecystectomy.Presentation of caseA 57-year-old woman was admitted to our hospital with epigastric pain. Gallstone disease in the gallbladder and common bile duct was diagnosed by ultrasonography and computed tomography. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiography (ERC) revealed that the aberrant cystic duct arose from the cystic duct and communicated with the intrahepatic bile duct of the posterior segmental branch. Laparoscopic cholecystectomy was successfully performed in combination with intraoperative cholangiography.DiscussionIf an anomaly of the biliary duct system is not identified during surgery, it may turn out to be a bile leak. The preoperative diagnosis of a double cystic duct allows laparoscopic cholecystectomy to be performed safely in combination with intraoperative cholangiography.ConclusionsA single gallbladder with double cystic duct is a very rare anomaly. However, laparoscopic surgery can be facilitated by the use of preoperative and intraoperative images.     

腹腔镜胆囊切除术中胆道造影与术前ERCP诊治可疑胆总管结石的临床比较

目的：比较腹腔镜胆囊切除术（laparosocopic cholecystectomy,LC）术中胆道造影与术前ERCP对诊治可疑胆总管结石的临床价值。方法：回顾分析2005年3月至2006年11月于LC术中行胆道造影43例患者与术前行ERCP63例患者的临床资料。结果：术中胆道造影组发现胆总管结石16例,阳性率占37.21%,造影不成功2例,占4.65%,无明显造影并发症,术前ERCP组发现胆总管结石19例,阳性率占30.16%,不成功13例,占20.63%,致术后胆道感染12例,急性胰腺炎9例,占33.33%。结论：术中胆道造影不仅简便,而且患者痛苦小,并发症少,治疗费用低,明显优于术前ERCP检查。     

腹腔镜胆总管探查一期吻合后术中胆道造影的临床价值

目的探讨在腹腔镜胆总管探查取石（laparoscopic common bile duct exploration,LCBDE）一期吻合后立即经胆囊管插管造影的临床价值。方法 2007年6月～2012年10月92例胆总管结石行腹腔镜胆总管探查一期吻合术,吻合后行胆道造影,术中发现胆道损伤、结石残留及时处理。结果术中造影显示74例吻合满意,吻合口漏6例,胆总管下段穿孔5例,右肝管漏2例,结石残留5例。吻合口漏及右肝管漏镜下补漏成功;胆总管下段穿孔5例开腹修补漏口;5例结石残留开腹直视下取净结石。92例术后均无胆漏、腹腔感染。78例随访1～72个月,平均20.6月,无胆管狭窄,2例术后30个月结石复发,1例术后12个月结石复发,EST取石。结论术中胆道造影在腹腔镜胆总管探查取石一期吻合术中可及时发现胆漏、结石残留,避免术后胆漏,值得临床推广。     

Managing bile duct injury during and after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is now the treatment of choice for gallstones, but there has been concern that bile leakage after a laparoscopic cholecystectomy is more frequent than after an open cholecystectomy. We have experienced 16 patients with bile duct injury after a laparoscopic cholecystectomy. Five patients had a circumferential injurury to the major bile duct, and we employed a converted open technique for biliary reconstruction. The other 11 patients had partial injurury to the major bile duct, and we performed laparoscopic restoration; all 11 of these patients received endoscopic retrograde cholangiography (ERC) on the day after the operation and stenting for biliary decompression and drainage. No complications were identified and the duration of hospitalization in these patients was significantly shorter than in those who had the converted procedure. If intraoperative cholangiography is performed routinely, the presence and form of bile duct injury can be clearly identified, and the decision to restore the site of injury or to convert to the open technique for biliary reconstruction can be made immediately. Received for publication on May 26, 1998; accepted on Aug. 28, 1998     

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。     

Posterior hepatic duct injury during laparoscopic cholecystectomy finally necessitating hepatic resection: case report.

A case of bile duct injury during laparoscopic cholecystectomy finally necessitating right hepatic lobectomy is reported to re-emphasize the importance of preoperative and intraoperative assessment of the biliary tree. A 47-year-old Japanese woman underwent laparoscopic cholecystectomy for cholecystolithiasis. On postoperative day 5, fever and right hypochondralgia developed, and CT revealed fluid collection at the right hypochondrium. Percutaneous drainage was performed, and subsequent fistulography revealed a communication of the cystic cavity with the right posterior bile duct, which suggested injury of the aberrant hepatic duct. Conservative therapy, including the adaptation of fibrin glue, was performed, but closure of the fistula and cavity was not obtainable. Finally, a right hepatic lobectomy was performed four months after cholecystectomy. In this case, endoscopic retrograde cholangiopancreatography was unsuccessful preoperatively, and intraoperative cholangiography was not done. This case report re-emphasizes that the preoperative and intraoperative examination of the biliary tree is mandatory to avoid bile duct injury.     

腹腔镜超声技术在胆囊切除胆道探查术中的应用

本文旨在探讨腹腔镜超声技术在LC中的临床应用价值和开创腔镜诊治胆石症的新途径。320例LC病有常规行腹腔镜超声检查(LUS);50例行腹腔镜超声和术中胆管造影(LOC)对比研究。胆管结石采用ERCP/EST和腹腔镜胆囊切除胆总管切开探查取石T管引流或一期缝合术治疗。结果显示LUS平均检查时间15min,对胆道系统和血管系统扫描结果显示:胆囊和门静脉100％显像,肝胆管胆总管98％显像,胆总管未端86％显像,3％发现未预期胆管结石,发现10％胆囊管解剖变异;LUS和IOC对比结果显示LUS胆总管结石敏感性、特异性和总诊断正确率均优于IOC(分别为83％、98％、98％和76％、95％、95％),两者结合则高达100％。ERCP/EST成功率达90％,30例腹腔镜胆总管探查取石术平均手术时间3.5小时,25例置T管引流、5例一期胆管缝合,均获成功,未发生胆漏胆管损伤等并发症,术后残石者经T管胆道镜取石治愈。因此,LC中常规使用腹腔镜超声技术有助于判断胆道生理和病理解剖结构、防止发生胆管损伤;有助于发现或排除肝内外胆管结石、为胆管造影和胆道探查术提供重要指征,降低胆道残石和阴性胆道探查术。腹腔镜超声指导下的腹腔镜胆囊切除胆道探查取石T管引流或一期胆管缝合术安全可靠、为胆石症微创外科诊断和治疗开辟了一条新途径。     

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。     

术中胆道造影在腹腔镜胆总管探查中的应用价值

目的:探讨术中胆道造影在腹腔镜胆总管探查中的应用价值。方法:回顾分析20例腹腔镜胆总管探查术中胆道造影的临床资料。结果:20例均获成功,其中腹腔镜胆总管探查T管引流术15例,一期缝合4例,胆总管受压纠正1例。治疗效果良好,全组无结石残留,胆漏1例、引流15d痊愈。结论:腹腔镜胆总管探查术中应用术中胆道造影术安全、可靠、避免了结石残留,具有临床推广价值。