胆道镜在肝内胆道手术中的应用

目的：探讨胆道镜在肝内胆管手术中的应用价值。方法：应用0lympus CHF—P20型纤维胆道镜及FUJINON EO-270F电子胆道镜在581例胆总管探查手术中处理肝内胆管病变。结果：明显减少了胆道术后残留结石的发生率，同时对胆道良、恶性狭窄配合手术治疗达到良好的效果。结论：术中胆道镜检查具有诊断治疗双重作用，可及时发现病变部位、程度，结合活检可对病变做出正确处理；配合器械取石可显著降低残石率的发生。

Operative Choledochoscopy in Intrahepatic Bile Duct Surgery

Objective To evaluate the role of operative choledochoscopy in intrahepatic biliary duct surgery Methods From 1999 to 2005, in this hospital, 581 patients with intrahepatic duct lesions have been treated using Olympus CHF-P 20 fiber choledochoscope or FUJINON EO-270 F electron choledochoscope in the bile duct exploration. The incidence of residual stones after operation and the efficacy for relieving benign and malignant biliary stenosis were investigated. Results Intra-and extrahepatolithiasis was revealed by operative chledochoscopy in 352 patients, left hepatolithiasis in 96 patients, right hepatolithiasis in 74 patients, and both left and right hepatolithiasis in 51 patients.Complete removal of stones of hepatic duct in one session was achieved in 532 patients(94.49%,532/563). Laser or electrohydraulic lithotripsy was performed in 15 pateints.Benign biliary stenosis was found in 214 patients, of whom were relieved using biliary dilatation procedure in 177 patients,plastic stent indwelling in 8 patients after biliary dilatation procedure,choledochojejunostomy and percutaneous or enteric biliary drainage in 7 pataients and metal stent indwelling in 18 patients with hilar bile duct carcinoma. Four biliary neoplasms were pathologically diagnosed as malignancy by means of frozen sectionbiopxy. Conclusion The advantages of operative cholesochoscopy for diagnosis and treatment are unquestionable, such as finding out the position and extent of lesions in time, managing the lesions accurately in accordance with biopsy,reducing the risk of residual stone by instrumental calculus removal.