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。

The Clinical Value of Intraoperative Cholangiography during Laparoscopic Common Bile Duct Exploration and PrimaryAnastomosis

Objective To explore the clinical value of cholangiography immediately after primary anastomosis in laparoscopic common bile duct exploration. Methods From June 2007 to October 2012, 92 cases of common bile duct calculi received the therapy of first-phase anastomosis after laparoscopic common bile duct exploration, followed by cholangiography. The biliary tract injury and stone residue found during the operation were timely handled. Results Cholangiography revealed that 74 cases of the anastomosis were satisfying, and the rest included 6 cases of anastomotie leakage, 5 eases of common bile duct lower segment punch, 2 cases of right hepatic duct leakage and 5 cases of residual calculi. The 6 cases of the anastomotic leakage and right hepatic duct leakage were repaired successfully under laparoscopy, the 5 cases of common bile duct lower segment punch were converted to open repair ventage treatment, and the residual calculi of the 5 cases were removed completely through laparotomy. All the 92 cases had no postoperative bile leakage and celiac infection. During the follow-up of 1 to 72 months （ an average of 20.6 months） of 78 patients, no bile duet stricture was observed while 3 cases of stone recurrence were found ：2 cases reccurred 30 months after the operation and 1 case reccurred 12 months postoperatively. Conclusion The intraoperative cholangiography after the first-phase anastomosis in laparoseopic common bile duct exploration can discover the bile leakage and residual calculi timely and avoid postoperative bile leakage, so it is worth wide clinical application.