腹腔镜胆囊切除术前静脉胆道造影的价值

Value of Intravenous Cholangiography Prior to Laparoscopic Cholecystectomy

目的 :探讨腹腔镜胆囊切除术前常规作静脉胆道造影的价值。方法 :回顾性总结我院 1991年 10月至1995年 6月术前所作的静脉胆道造影 1971例 ,分析造影结果与胆囊的病理改变、胆管结石、手术难度及手术时间长短的关系。结果 :胆囊显影良好者 ,其胆囊的急性炎症、重度粘连、胆囊颈管的结石嵌顿、胆囊积液积脓、胆囊萎缩等病理改变的发生率均明显低于胆囊不显影、显影浅淡及肝外胆系不显影者。其平均手术时间也明显低于后三者。在B超未揭示胆管异常的情况下 ,发现胆管结石 5 9例 ,占作静脉胆道造影病例的 3% ,均经手术证实。结论 :腹腔镜胆囊切除术术前常规作IVC能充分预见胆囊及其周围的病理改变、发现胆道解剖结构的异常、预测手术难度、筛检胆管结石 ,避免胆道损伤 。

Objective:To evaluate the value of routine use of intravenous cholangraphy(IVC)prior to laparoscopic cholecystectomy(LC).Methods:From October 1991 to June 1995 in our hospital,1971 cases with intravenous cholanggraphy as preoperative examination in laparoscopic cholecystectomy were studied.The relations between the result of IVC and pathological changes of gallbladder,the common bile duct stone,the difficulty and the length of the operation were analyzed.Results:The rate of complication,such as acute inflammation of the gallbladder,severe adhesion,cystic duct(or neck)stone obstruction,emphysema hydrops of gallbladder,atrophy of gallbladder and so on,was apparently lower in the cases with clear image of the gallbladder than in those with poor or no image of gallbladder and extrahepatic billiary duct.And the average time of operation for the former was also much less than that for the latter.With no indication of abnormal common bile duct by Ultrasonograph B,59 cases,about 3% of the whole 1971 cases checked by IVC,were found to be common bile duct stone and also confirmed by surgery.Conclusion:Routine use of intravenous cholangiography prior to laparoscopic cholecystectomy can qreatly predict the pathological changes of the gallbladder and its surroundings,find the abnormal structures of the bile duct,predict the difficulty of the operation,screen common bile duct stone and avoid the injury of the bile duct.IVC should be used as routine examination prior to LC.