胆道造影在LC术中的应用价值探讨

Application Value of Cholangiography in Laparoscopic Cholecystectomy

目的探讨胆道造影在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法选择我院于2008年1月至2012年12月行LC患者454例作为研究对象,将其随机分为两组:观察组,n=227,行LC给予胆道造影;对照组,n=227,单纯行LC。对比分析两组患者的临床效果。结果观察组LC术中胆道造影成功221例,成功率为97.4%(221/227),术中发现胆总管结石7例,比例约为3.2%(7/221),均中转开腹行胆总管切开取石术,一次成功;胆道造影后肝功能轻度异常4例(1.8%,4/221),淀粉酶轻度升高2例(0.9%,2/221);造影良好未见术后并发症;227例患者均一次成功治愈出院。对照组患者中转开腹14例,中转开腹率为6.2%(14/227);术后并发症11例(4.8%,11/227);227例患者均治愈出院。结论 LC术中行胆道造影,不仅造影成功率较高,而且由于现象清晰,能够有效帮助术者检查胆道,既有效提高了LC术的成功率,更能够有效避免因为二次手术给患者带来的痛苦。

Objective To investigate the application value ofcholangiography in laparoscopic cholecystectomy （LC）. Methods 454 casees of LC patients who had undergone LC in our hospital from January 2008 to December 2012 were selected and randomly divided into two groups： the observation group （n = 227） were give cholangiography by LC; the control group （n = 227） received LC alone. Clinical effect of two groups were compared and analyzed. Results In observation group, intraoperative cholangiography （IOC） by LC was successful in 221 patients, with success rate of 97.4% （221/227）. Common bile duct stone was found in 7 cases, the ratio was about 3.2% （7/221）. They were all converted to laparotomy performed choledocholithotomy and were successful by one-time operation. Mild Abnormal liver function after cholangiography was occurred in 4 cases （1.8%, 4/221）, amylase mildly elevated in 2 cases （0.9%, 2/221）. Contrast was good, without postoperative complications. All of 227 patients in the observation group were successfully cured. In the control group, 14 cases were converted to open surgery, and the lap^otomy rate was 6.2% （14/227）. Postoperative complications occurred in 11 cases （4.8%, 11/227）. All 227 patients were cured and discharged. Conclusions LC intraoperative cholangiography has not only the high success rate, but also the clear phenomenon, which can effectively improves the success rate of LC operation, and avoid the pain caused by twice operation.