微切开取石治疗胆管结石的优越性

Advantages of mini-incision to remove bile-duct stones

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.