摘要
目的探讨胆管微切开取石术治疗胆管结石的优越性,进一步明确胆管取石后放置T管的适应范围。方法针对85例实施胆管微切开手术的患者,运用磁共振胰胆管造影(MRCP)、AdvantageWorkstationAW4.2~0.7sdc软件、术中胆管镜成像系统、图画等方法,对胆管微切开取石的适用范围进行了系统性讨论。结果研究提示,绝大多数胆管结石患者的胆总管宽度在8mm以上,而胆管的宽度可能与结石的大小和多少相关。胆管宽度≥11mm(n=16)的MRCP结石影像面积较胆管宽度〈11mm(n=14)的MRCP结石影像面积显著性增大[(148-467)mm^2比(47±31)mm^2,P%0.05]。对于胆总管下段非游离、多发、结构致密结石,由于一次性彻底取石困难,需留置T管引流以备二次胆管镜检查。结论胆管微切开取石技术可避免大多数不必要的术后T管处理,尤其适合于早期诊断的胆管结石。T管引流多仅限于一次性彻底取石困难、病情复杂的患者。
Objective To explore the advantages of the technique of bile duct mini-incision (BDM) for stone removal in choledocholithiasis, and to further clarify the indications for T-tube inser- tion during surgery. Methods 85 BDM operations were performed. The use of MRCP (Magnetic res- onance cholangiopancreatography), Advantage Workstation AW4. 2-0. 7sdc software, choledocho- scopic imaging system and illustrations were used to study the applicability of the BDM technique in stone removal. Results The width of common bile duct (CBD) was usually over 8 mm in the patients with choledocholithiasis, and the width was related to the number and size of the stones. In the pa- tients who had a CBD width of over llmm (n: 16), the MRCP stone imaging area (MRCP-SIA) was significantly larger when compared with that [(148±67)mm2 vs. (47±31)mm2 , P〈0.05] in the pa- tients (n: 14) with CBD width of less than 11 ram. T-tube insertion for secondary choledochoscopic examination should be performed when the stones were non-drifting, multiple, and closely related to the lower part of CBD indicating difficulty in complete stone removal. Conclusions Unnecessary T- tube insertion could be avoided by the BDM technique for stone removal which was especially suitable for patients with early diagnosis of choledocholithiasis. T-tube insertion should only be performed in patients with difficulty in complete stone removal and in other complicated situations.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2012年第9期668-670,共3页
Chinese Journal of Hepatobiliary Surgery
关键词
胆总管结石
外科手术
微创性
引流术
Choledocholithiasis
Surgical procedures, minimally invasive
Drainage