术中纤维胆道镜经胆囊管胆道探查取石的临床研究

Practical application of choledochofiberscopic common bile duct exploration through cystic duct

目的讨论术中纤维胆道镜经胆囊管行胆道探查及取石的技术要点及临床价值。方法在行胆囊切除手术中,将纤维胆道镜通过胆囊管开口插入胆道进行探查取石等操作,完成后结扎胆囊管,总结分析388例临床资料。结果确诊胆道结石271例,胆汁混浊或结石碎屑49例,探查正常68例,阴性率17.53%,与胆管切开T管引流术比较,手术并发症发生率降低(χ2=4.16,P<0.05),术后平均住院日缩短(t=23.21,P<0.05)。结论术中纤胆镜经胆囊管行胆道探查及取石手术具有简便、微创、降低胆管盲目切开率,手术并发症少,术后恢复快等优点。

Objective To explore the clinical value and operative techniques in choledochofiberscopic treatment for bile duct exploration and cleaning calculus during cholecystectomy. Methods 388 cases underwent choledochofiberscopy through cystic duct for bile duct exploration and calculus cleaning. Cystic duct was clipped during cholecystectomy. The data were analyzed retrospectively. Results Within 388 patients, 320 cases were found calculus, 68 cases were not found, and the negative rate was 17.53%. Compared with traditional open choledocholithotomy T drainage, the rate of complications was decreased （x^2=4.16,P〈0.05）,and the postoperative hospitalization time was reduced （t=23.21,P〈0.05）. Conclusions Using choledochofiberscopic treatment for bile duct exploration and cleaning calculus during operation is simple, convenient, minimally invasive, and can avoid to open common bile duct sightlessly. It also has fewer complications, shorter hospitalization time.