腹腔镜胆囊管残端部分开放联合胆道造影在胆囊管结石治疗中的应用

目的探讨胆囊管残端部分开放联合胆道造影在胆囊管结石治疗中的临床应用价值。方法2010年2月～2012年12月，对55例胆囊管结石行四孔法腹腔镜胆囊切除术。全麻，术中明确“三管”关系后夹闭胆囊管近侧端，剪开远侧部分胆囊管管壁，钝性挤压远端，挤出可能残留结石直至清亮胆汁流出，自胆囊管开放口置管行术中胆道造影，判断有无结石残留。术后观察腹部症状体征、肝功能指标，常规行B超复查，必要时行MRCP检查，明确有无胆囊管结石残留或继发胆总管结石残留。结果55例手术均获成功。术中经胆囊管残端开放钝性挤压，15例有残留小结石挤出。术中胆道造影，1例发现继发胆总管结石残留，多次反复挤压取石失败，术后第3日行ERCP＋EST取石成功，余54例无结石残留。术后2例不明原因上腹疼痛，肝功能、B超及MRCP检查均无异常，予以对症解痉治疗后腹痛缓解，余均顺利康复。结论对胆囊管结石行腹腔镜胆囊切除术时，采用胆囊管残端开放法，通过钝性挤压胆汁溢出，冲出可能残留结石，辅以经胆囊管残端插管胆道造影，及早发现胆囊管结石残留或继发胆总管结石残留，增加腹腔镜胆囊切除术的安全性。

Application of Cyst Duct Partial-open Combined with Cholangiography in the Treatment of Cystic Duct Stones

Objective To explore the efficacy of cystic duct partial-open combined with cholangiography in the treatment of cystic duct stones. Methods From February 2010 to December 2012, 55 cases with cystic duct stones underwent laparoscopie cholecystectomy （LC）. During the procedure, after the identification of the relationship between the ＂three ducts＂, we opened partly the distal part of the cystic duct and pressed the biliary tract from the direction of the common bile duct to the cystic duct until we saw the clear bile coming out. Then we performed eholangiography through the open part of the cystic duct to check whether there were residual stones or not. Postoperative care and observation were performed to detect any possible complications. Results All the cases underwent LC successfully. Small residual stones coming out from the distal part of the cystic duct could be seen under pressure in 15 eases. One case with residual stone was resolved by post-operative ERCP ＋ EST on the 3rd postoperative day. Two cases suffered abdominal pain with unclear reason and recovered soon after conservative therapy. Others all recovered well with no signs of residual stones. Conclusion Cystic duct partial-open combined with cholangiography is easy to perform during the procedure of LC and is very effective in the prevention of residual stones after LC, which guarantees the effect of LC.