术中微切开胆道镜检查的可行性研究

目的探讨经胆囊管汇入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2～3mm,然后经此切开处置入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1996年12月至2003年8月已施行此术式42例。发现肝外胆管结石26例54枚,术中结石取净率为100%(26/26),阴性探查16例。胆道镜检查或协助取石时间在5～20min,平均用时10min,无一例胆瘘发生。术后住院时间7～10d,平均为8d。38例得到随访,随访时间为3～24个月,平均为14个月。经B超和CT证实,无一例有胆道狭窄表现。结论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,免除了病人术后的带T管痛苦,减少了术后并发症,缩短了术后住院时间,并且适于大部分胆道结石的病人,值得推广应用。

Cholangiscopic check through mini-incision in joint of CBD and cystic duct

Objective To investigate the safety and possibility of directly sewing CBD up after cholangiscopic check with cholangiscopy through the mini-incision in the joint of CBD and cystic duct. Methods An incision of 2-3 cm was made in the joint of CBD and cystic duct in the patients who had indication for exploration. Then the cholangioscope was placed in CBD through this incision. The incision was directly sewed up after the exploration. Results We had applied this method in 42 patients from December 1996 to August 2003. Fifty-four pieces of stones were fond in extrahepatic biliary tract in 26 patients, and nothing was found in the other 16. The mean duration of postoperative hospitalization was 8 d. Thirty-eight patients were followed up with B-mode ultrasonography and CT scanning for a mean of 14 months. It was found that no biliary tract stricture occurred in these 38 patients. Conclusions Operative cholangiscopy through the mini-incision in the joint of CBD and cystic duct is safe and convenient and can be used in most of the patients needing CBD exploration because it can shorten the hospitalization duration of and alleviate symptoms in the patients.