磁共振胰胆管成像术下的胆囊管形态分型在腹腔镜处理胆总管结石路径选择中的价值

The best pathway in the laparoscopic surgery for choledocholithiasis according to the type of cystic duct undergoing MRCP

目的：探讨腹腔镜处理胆总管结石的最佳手术路径的选择。方法根据磁共振胰胆管成像术（MRCP）将154例患者的胆囊管分成4型，对粗直型（n ＝89）及细弯型（n ＝65）病例随机采取经胆囊管及胆管切开途径的胆道探查。统计手术时间、中转率、并发症发生率、术后住院时间等，进行对照分析。结果粗直型经胆囊管手术46例，胆管切开途径43例，前者手术时间、术后住院时间均较后者短（P ＜0．05），中转率及并发症发生率差异无统计学意义。细弯型经胆囊管手术32例，胆管切开途径33例，2组手术时间、术后住院时间、中转率及并发症发生率差异均有统计学意义（P ＜0．05）。结论根据 MRCP 胆囊管形态分型，选择腹腔镜处理胆总管结石手术途径，如粗直型以经胆囊管途径、细弯型以胆管切开途径，可最大限度发挥腔镜的微创优势。

Objective To investigate the best pathway of laparoscopic surgery for choledocholithiasis. Methods According to MRCP,the cystic duct was divided into four types.The thick-straight type （n =89）and the thin-crooked type （n =65）patients randomly received the laparoscopic operations via the cystic duct or com-mon bile duct.The operation time,transit operation rate,complication rate and length of hospital stay after opera-tion were analysed.Results There were 46 cases of the thick-straight type via cystic duct,43 cases via common bile duct.The former had shorter operation time and hospital stay after operation （P〈0.05）,but there was no significant difference in transit operation rate and complication rate.There were 32 cases of the thin-crooked type via cystic duct and 33 cases via common bile duct and there were significant differences in the operation time, transit operation rate,complication rate and length of hospital stay after operation（P〈0.05）.Conclusion Ac-cording to different types,LCTBDE is suitable for the patients with thick-straight type,and LCHTD can be per-formed in thin-crooked type.Therefore,it can maximize the advantage of minimally invasive surgery.