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.

The value of intraoperative cholangiography through cystic duct for detection of occult common bile duct stones and iatrogenic bile duct injuries during laparoscopic cholecystectomy

Objective To discuss the clinical value of intraoperative cholangiography （IOC） through cystic duct for detection of occult common bile duct stones（CBDS） during laparoscopic chole cystectomy（LC）.Methods To analyse retrospectively the clinical data of 341 cases who had gone through laparoscopic cholecystectomy,including 137 patients （experimental group） concurrently ac cepted cholangiography through cystic duct,other 207 patients （control group） did not receive cholan giography.Results Eleven（8.03％） cases in the experimental group were found to have common bile duct stones and 1 （0.72％） case were found to have bile duct injuries.However,in the control group,5（2.45％） cases were found to have common bile duct stones and 0 case were found to have bile duct injuries.In the postoperative follow up periods of 3 6 months,4（2.92％） cases in the experimental group and 18（8.82％） cases in control group were found to have retained calculus in biliary tracts,0cases in the experimental group and 2（0.98％） cases in control group were found to have bile duct in juries.Conclusions Intraoperative cholangiography through cystic duct is a safe,quick and noninva sive technique,The method maximizes the intraoperative detection of common bile duct stones,promptly found bile duct injuries then reduce the incidence of residual stones and could avoid unneces sary exploration of the common bile duct.