胆囊管狭曲畸形的解剖特点及腹腔镜手术治疗

Anatomical features and laparoscopic surgery of narrow-winding cystic duct deformity

目的:探讨胆囊管狭曲畸形的解剖特点及其手术指征和操作要点。方法:采用MRCP、腹腔镜胆囊切除术中图像捕捉等方法,分析31例病人的解剖特点。行腹腔镜胆囊切除术时,对胆囊周围存在粘连者予充分松解,全程游离并切除胆囊管。观察本组手术治疗后的效果。结果:16例存在胆囊与周围组织粘连,19例胆囊壶腹部与胆囊管界限不明显。所有病例的胆囊管经测量有冗长、狭窄、严重扭曲的特点,经顺行或逆行腹腔镜胆囊切除术后病人恢复良好,右上腹不适等症状缓解。结论:对于胆囊管狭曲畸形,要熟悉其解剖特点,行腹腔镜胆囊切除时采取有针对性的措施,以获得良好的治疗效果。

Objective To investigate the anatomical features, indications and strategy of ]aparoscopic cholecystectomy in treating cases of narrow-winding cystic duct deformity. Methods The anatomical features of 31 patients with narrow-winding cystic duct deformity were studied by MRCP and pictures captured during the operation. During the laparoscopic cholecystectomy, the adhesions around the gall bladder was seperated. And the redundant cystic duct was totally exposed and resected. The whole course of the operation was reviewed and evaluated. Results Adhesion around the gallbladder was found in 16 cases. And the boundary between Hartmann＇s pouch and the cystic duct was far from being clear-cut in 19 cases. In all cases, the cystic duct was long, narrow and winding. After an anterograde or retrograde laparoscopic cholecystectomy, each patient recovered satisfactorily with amelioration of symptoms. Conclusions To obtain a good therapeutic result, the anatomical features of narrow-winding cystic duct deformity should be well understood, and anatomy-based techniques should be adopted in order to carry out a successful laparoscopic cholecystectomy.