经胆囊管胆道镜检查取石56例

Intraoperative choledochoscopy through the cystic duct:a report of 56 cases

目的:探讨经胆囊管或其汇入部微切开行胆道镜检查的可行性及适应证。方法:对具有胆道探查指征的患者,施行经胆囊管或其汇入部切开约2mm后进行胆道镜检查和取石,探查完成后不放置T管,直接结扎或缝合胆囊管及汇入部微切口。结果:施行经胆囊管胆道镜检查22例,经胆囊管汇入部微切开检查34例,成功53例。术后住院时间7～10d,平均8.6d,无一例胆漏发生。47例得到随访,随访时间3月～4.5年,平均32月,无一例结石复发或胆道狭窄表现。结论:与传统的胆总管切开胆道镜检查相比,经胆囊管或其汇入部微切开胆道镜检查具有创伤小,术后反应轻,术后住院时间短,免除了术后带T管的痛苦,减少了术后并发症等优点,适应于大部分胆道结石患者。

Objective：To investigate the feasibility and efficacy of intraoperative choledochoscopy for patients with common duct stones （CDS）, suspicious CDS and choledochectasia through the cystic duct. Methods. From June 2002 to December 2006, intraoperative choledochoscopy through the cystic duct and the mini - incision at the joint of bile common duct （CBD） was performed in 56 patients suitable for CBD exploration. After choledochoscopy, the cystic duct was ligatured or the incision was directly sewed up without T -tube-drainage. Results： choledochoscopy was performed successfully in 21 （95.5%） patients through the cystic duct and in 32 （94. 1% ） patients through the mini - incision. The mean postoperative hospitalization was 8.6 days （ range, 7 to 10 days）, and no bile leakage was found in all patients after surgery. During a mean follow - up period of 32 months, no patients had stricture of bile duct or recurrence of common duct stones. Conclusion： Intraoperative choledochoscopy through the cystic duct or the mini - incision at the joint of CBD is feasible and efficient in majority of the patients suitable for CBD exploration, which can possess the advantages of avoiding intraoperative T -tube placement and shortening the postoperative hospitalization time.