共查询到18条相似文献,搜索用时 531 毫秒
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钱之秋 《全科医学临床与教育》2009,7(3):298-299
急性胆囊炎由于局部充血水肿,周围粘连,胆囊颈部结石嵌顿,胆囊三角区解剖关系不清、胆道合并结石率高等因素,急诊胆囊切除术后胆管结石残留率及胆管损伤发生率比择期手术高。胆道造影有助于判断胆道结构及合并病变,本次研究将术中胆道造影(intraoperative cholangiography,IOC)技术应用于因急性胆囊炎而行腹腔镜胆囊切除术的患者,来评估其价值。 相似文献
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腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)与传统的胆囊切除术(opencholecystectomy,OC)相比,具有创伤轻,痛苦小,住院时间短等优点,因此,逐渐成为治疗单纯性胆囊炎的首选术式。本院外科自2002至2005年对78例急性胆囊炎患者行腹腔镜胆囊切除术,同时应用术中胆道造影技术(intraoperative cholangiography,IOC),有效地提高了手术质量,减少胆管损伤的发生,现报告如下。 相似文献
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王晓军 《临床和实验医学杂志》2012,11(6):429-431
目的探讨术中胆道造影在腹腔镜胆囊切除术(LC)中的临床应用价值。方法分析2006年9月至2010年12月北京丰台长辛店医院及东城区第一人民医院180例慢性结石性胆囊炎、急性结石性胆囊炎、胆源性胰腺炎患者行LC患者的临床资料,统计分析其中20患者在术中经胆囊管插管行胆管造影(IOC)的临床数据。结果 20例LC术中胆管造影18例成功,成功率90.0%,术中发现胆总管结石2例,经中转开腹行胆总管切开取石,胆管变异1例;平均造影时间15±10.50 min。结论 LC中胆管造影操作较为简单方便、显影清晰、成功率高,既能发现术前未能发现的胆总管结石,又能发现胆管解剖变异;并能够有效地降低胆管残石率,及时发现术中胆管损伤,提高了LC的手术质量和安全性。 相似文献
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杨兴建 《中国临床实用医学》2010,4(10):137-138
目的探讨腹腔镜胆囊切除术中胆道造影的临床价值。方法回顾性分析69例经腹腔镜胆囊切除术中经胆囊管行胆道造影的临床资料,并加以总结。结果造影成功69例,成功率100%,术中造影发现胆总管结石8例,胆道结构变异3例,胆管损伤1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。 相似文献
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目的探讨经胆囊壶腹皱襞入路的腹腔镜胆囊切除术(LC)在预防胆道损伤中的临床效果,为临床应用提供指导。方法选择2015年12月至2016年5月鄂尔多斯市中心医院康巴什部经胆囊壶腹皱襞入路精细解剖胆囊三角技术行LC的120例胆囊结石及胆囊息肉患者为研究对象,对其临床资料进行分析。结果以胆囊壶腹与肝十二指肠韧带之间的凹陷或切迹(即胆囊壶腹皱襞)为解剖学标志,显露胆囊管、肝总管、胆总管及胆囊动脉,120例患者均顺利完成了LC,术中未发生胆道损伤。结论在LC中采用经胆囊壶腹皱襞入路可有效预防术中胆道损伤的发生,值得临床推广应用。 相似文献
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腹腔镜胆囊切除术中胆囊管结石的处理 总被引:2,自引:1,他引:1
目的探讨LC中胆囊管结石的诊断、手术方法及术后并发症的预防。方法该组216例胆囊管结石行LC,在结石远段胆囊管上钛夹,将结石推入胆囊内或直接切开胆囊管取石,行术中胆道造影37例,胆道镜检查取石14例,放置T管51例,放置腹腔引流管142例。结果所有病例均顺利完成手术。无中转开腹,无胆漏;2—4d后拔除腹腔引流管,2—6周拔除T管。3例分别于术后1,3和10d出现腹痛,B超发现结石掉入胆总管,行EST取出结石。结论胆囊管结石在LC术中越来越多见,正确诊断选择适当的处理方法,必要时行术中胆道造影及胆道镜检查是提高手术成功率的关键。 相似文献
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目的 探讨对于有胆道相对探查指征的病人行腹腔镜胆囊切除术时术中胆道造影的应用价值。方法 对 112例腹腔镜胆囊切除术中经胆囊管胆道造影病人临床资料进行回顾性分析。结果 112例有相对胆道探查指征的病人行腹腔镜胆囊切除术时附加术中胆道造影阳性发现 2 3例 (2 0 . 5 3 % ) ,假阳性 1例 (0 . 89% ) ,中转开腹手术 7例 (6 .2 5 % ) ,没有胆道残余结石。结论 腹腔镜胆囊切除术中胆道造影可降低胆道阴性探查率 ,扩大腹腔镜胆囊切除术的手术适应证。 相似文献
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目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊管解剖变异的诊断及处理。方法:回顾分析1999年1月—2013年12月在复旦大学附属中山医院青浦分院行LC的4652例患者的临床资料,其中胆囊管发生解剖变异者34例,包括胆囊管异常粗、短11例,高位汇入右肝管7例,低位汇入肝总管下端6例,从肝总管前方绕至左侧汇入肝总管1例,与肝总管并行一段后汇入胆总管3例,Mrizzi综合征4例,内脏反位2例。结果:34例胆囊管有解剖变异的患者中,22例成功行LC,12例中转开腹行胆囊切除术。9例出现并发症,均为胆管损伤,经处理后恢复良好,无远期并发症发生。结论:LC术前难以诊断胆囊管解剖变异,LC术中重视胆囊管解剖变异、细致地解剖胆囊三角、辨认各管道关系,是预防并减少胆管损伤的关键。 相似文献
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Hsing-Ying Lin Chen-Han Huang Shannon Shy Yu-Chung Chang Hsiang-Chen Chui Tsung-Chih Yu Chih-Han Chang 《Biomedical optics express》2012,3(9):1964-1971
Bile duct injury (BDI) is the most serious iatrogenic complication during laparoscopic cholecystectomy (LC) and occurs easily in inexperienced surgeons since the position of common bile duct (CBD) and its related ductal junctions are hard to precisely identify in the hepatic anatomy during surgery. BDI can be devastating, leading to chronic morbidity, high mortality, and prolonged hospitalization. In addition, it is the most frequent injury resulting in litigation and the most likely injury associated with a successful medical malpractice claim against surgeons. This study introduces a novel method for conveniently and rapidly indicating the anatomical location of CBD during LC by the direct fiber-optic illumination of 532-nm diode-pumped solid state laser through a microstructured plastic optical fiber to avoid the wrong identification of CBD and the injury from mistakenly cutting the CBD that can lead to permanent and even life threatening consequences. Six porcine were used for preliminary intra-CBD illumination experiments via laparotomy and direct duodenal incision to insert the invented CBD illumination laser catheter with nonharmful but satisfactory visual optical density.OCIS codes: (170.1610) Clinical applications, (170.2945) Illumination design, (170.2680) Gastrointestinal 相似文献
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目的 探讨医源性胆管损伤的原因及应用胃胆管的治疗效果.方法 回顾性分析9例医源性胆管损伤患者的临床资料.结果 9例患者的胆管损伤均在术中及时发现.5例系金属探条暴力所致,2例取石钳损伤,1例腹腔镜分离钳损伤,1例肝总管横断.经注水试验、胆管造影或胆道镜检查证实后,即在胆总管内置入细硅胶管(胃胆管)经十二指肠乳头、幽门、胃前壁引出固定于腹壁,胃胆管头端固定有自制弹力圈以防自胆管脱出.常规于胆管损伤处或后腹膜胆总管损伤处置引流管.9例患者均恢复顺利,8例胃胆管引流6~10 d后拔除,1例30 d后拔除,随访9个月至5年,未出现胆管狭窄、腹膜后感染等并发症.结论 术中胆道镜、胆管注水试验和术中胆管造影有助于诊断;胃胆管引流对胆管损伤有一定应用价值,但临床应用例数太少,有待进一步积累资料和观察. 相似文献
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Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts
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Toshihiro Kitajima Yasuhiro Fujimoto Etsuro Hatano Yusuke Mitsunori Koji Tomiyama Kojiro Taura Masaki Mizumoto Shinji Uemoto 《Asian journal of endoscopic surgery》2015,8(1):71-74
Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71‐year‐old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5‐cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso‐biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst. 相似文献