“胆总管窗”的临床研究

Clinical Study of "Common Bile Duct Window"

目的为预防胆管损伤,提出一个新的腹腔镜下的解剖学标志——"胆总管窗"。方法选择2005年11月10日至2006年3月6日期间在我院行腹腔镜胆囊切除的患者60例,观察术中"胆总管窗"的大小、形态以及与周围解剖结构的关系;统计"胆总管窗"的出现率,并记录患者年龄、性别、病程、体重指数(BMI)、甘油三酯以及胆固醇水平、胆囊壁厚和炎症情况;分析"胆总管窗"的出现率与这些因素之间的关系。率采用χ2检验,均数采用t检验。结果"胆总管窗"位于肝十二指肠韧带下端,距十二指肠帽部上缘(0.50±0.25)cm,距胆囊管汇入部下方约(1.80±0.70)cm,呈纵向卵圆形,纵轴与胆总管走向一致,长轴约(1.20±0.60)cm,横轴约(0.45±0.30)cm。"胆总管窗"的出现率为81.6%(49/60),与患者的年龄、性别、病程、BMI、血脂均无明显关系(P>0.05),而胆囊炎症明显、胆囊壁增厚时,则不容易观察到"胆总管窗"(P<0.05)。结论"胆总管窗"是一个不受人群因素影响的解剖结构,并能够很好地提示胆总管的走向和位置。术中以此窗为解剖学标记进行操作,将有助于减少腹腔镜下胆管损伤的发生率。

Objective To prevent bile duct injury, a new anatomy marker, named ＂common bile duct window＂ is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including： age, gender, course of disease, body mass index （BMI）, blood lipid level （triglyceride and cholesterol）, the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of ＂common bile duct window＂ were recorded and calculated. Patients were divided into two groups according to the presence of ＂common bile duct window＂, and the diference of data between two groups was analyzed by using x^2 test or t test. Results ＂Common bile duct window＂ was found at the end of hepatoduoduenal ligament with oval shaped, the mean longitude of ＂common bile duct window＂ was （1.20±0.60） cm, and mean width was （0. 45±0. 30） cm. ＂Common bile duct window＂ were found in 81. 6% （49/60） of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of ＂common bile duct window＂ （P〉0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P〈0.05）. Conclusion An oval-shaped ＂common bile duct window＂ can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through ＂common bile duct window＂, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct iniuries can be effectively decreased by the oresence of ＂common bile duct window＂.