磁共振胆胰管成像结合钝性冷分离在腹腔镜胆囊切除术中的应用

Application of magnetic resonance cholangiopancreatography combined with blunt cold dissection of Calot triangle in laparoscopic cholecystectomy

目的探讨磁共振胆胰管成像(MRCP)结合钝性冷分离在腹腔镜胆囊切除术在腹腔镜胆囊切除术(LC)的效果。方法对拟行LC的581例患者术前常规行MRCP检查,共发现胆总管结石13例,胆囊管变异29例,副肝管5例,Mirizzi综合征2例。完成LC共556例,切断胆囊管前均常规采用钝性冷分离法处理Calot三角,明确肝总管和胆总管后再切断胆囊管。结果全组无胆总管结石残留及胆道损伤病例。13例中转开腹手术;1例出现术后腹腔出血,行剖腹探查术后痊愈出院。结论 LC术前常规行MRCP检查可准确显示无征兆胆总管结石及胆管解剖变异;根据术前MPCP评估,结合术中钝性冷分离方法解剖Calot三角,可有效防止术中的胆道损伤。

Objective To investigate the outcomes of magnetic resonance cholangiopancrea- tography（MRCP） combined with blunt cold dissection of Calot triangle in the patients undergoing laparoscopic cholecystectomy（LC）. Methods MRCP was performed in 581 patients with gallstone,of whom 13 cases were with stones in the comon bile duct, 29 cases were with variant cystic duct, 5 cases were with accessory hepatic duct, and 2 cases were with Mirizzi syndrome. LC was performed on 556 patients. During operation, the common hepatic duct was exposed by blunt cold dissection（without Hookelectrode） before transecting the cystic duct. Results There were no cases with bile duct injury or residual stones in the eomon bile duct. Thirteen cases were converted to open surgery. Bleeding in abdominaI cavity occurred after operation in 1 case, who recovered well after reoperation. Conclusion MRCP before operation can show a definete diagnose of asymptometic stones in the comon bile duct and variant cystic ducts. Bile duct injury may be avoided effectively by MRCP before operation and blunt cold dissection of Calot triangle during operation.