胆囊管汇入部微切开入路胆道镜检查的临床分析

目的探讨术中经胆囊管汇人部微切开入路胆道镜检查后一期缝合的可行性和安全性。方法对具有胆道探查指征的病人，施行胆囊管汇入部切开约2～3mm，然后经此切开处置人胆道镜进行检查和治疗。探查完成后，不放置T管，直接（一期）缝合胆囊管及汇入部微切口。结果自2006年1月至2008年10月间，已施行此术式22例。发现肝外胆管结石12例21枚，术中结石取净率为100％（12／12），阴性探查10例。胆道镜检查或协助取石时间为10～30min，平均15min，无1例发生胆瘘。术后住院时间为7，10d，平均8d。22例得到随访，随访时间为3～24个月，平均为14．6个月。经B超和CT证实，无1例有胆管狭窄表现。结论术中经胆囊管汇入部微切开入路进行胆道镜检查，与传统的经胆总管前壁切开入路相比具有创伤小、病人术后反应小、安全、方便等优点。此方法免除了病人术后带T管的痛苦，减少了术后并发症，缩短了术后住院时间，并且适用于大部分胆道结石的病人。

Choledochoscokpe check through mini-incision in joint of common bile duct and cystic duct

Objective To investigate the safety and possibility of directly sewing common bile duct (CBD) after choledochoscope check through the mini-incision access at the confluence part of CBD and cystic duct.2～3 mm incision was made in the confluence part of CBD and cystic duct on patients with exploration indication. Then the choledochoscope was inserted into CBD through this incision for the examination and treatment. After exploring, the incision was sewed up directly. Results 22 cases received operation by this method from January 2006 to October 2008. 21 pieces of stones were found in extra hepatic biliary duct in 12 cases, and nothing was found in 10 cases, the mean postoperative hospitalization time was 8 days. 22 cases were followed up with B ultrasound and CT, the mean time of following up was 14.6 months, none had biliary duct stricture. Conclusion choledochoscopy through mini-incision at the confluence of CBD and cystic duct is safe and convenient and could be applied in most cases that need CBD exploration. It could shorten the hospitalization time and alleviate the suffering of patients.