经胆囊管胆道造影、胆总管探查在胆囊切除术中的应用186例报道

Application of Intraoperative Cholangiography and Common Bile Duct Exploration through Cystic Duct in 186 cases

目的探讨经胆囊管造影、胆管探查在单纯胆囊切除术中的应用价值。方法术前临床诊断为胆囊结石、胆囊息肉样病变的患者,有186例在胆囊切除术中经胆囊管行胆道造影、胆总管探查。分析胆道病变及其相应处理手段、疗效。结果通过经胆囊管造影和探查,术中发现胆总管结石49例,经胆囊管取石11例,胆总管切开取石38例;胆囊管冗长6例。均予切除冗长部分;胰胆管合流异常13例,未处理;胆总管末端双开口2例,未处理。所有患者均无结石残留、胆囊管残余。结论术中经胆囊管胆道造影、胆总管探查可发现术前漏诊的胆总管结石和其他病变,且大部分结石可经胆囊管取出。

Objective To evalute the effects of cholangiography and common bile duct exploration through cystic duct in cholecystectomy for simple cholecystitis. Methods Analyze retrospectively 186 cases had intraoperative cholangiography of 574 diagnosed as simple gallbladder stone or cystic polypus lesions. Results Choledocholith was found in 43 cases, 27 were removed through cystic duct, 16 by choledochendysis. 6 cases of long and tortuous cystic duct were found and excises. 13 cases of anatomical variation of pancreasticobiliary duct were found without treatment. No residual stone or lengthy cystic duct were found in all cases. Conclusions Intraoperative cholangiography and common bile duct exploration through cystic duct can discover mis-diagnosed choledocholithiasis and other lesions during cholecystectomy. Most of the common bile duct calculi can be removed through the cystic ducts.