选择性经胆囊管胆道造影在急诊腹腔镜胆囊切除术中的应用

Applicationof selected via cystic duct cholangiography in emergency laparoscopic cholecystectomy

目的分析选择性经胆囊管胆道造影应用于急诊腹腔镜胆囊切除术患者的效果。方法回顾性分析2013年4月~2016年4月于北京市垂杨柳医院急诊胆囊炎急性发作行腹腔镜胆囊切除术128例患者的临床资料,根据手术方式分成两组,常规组82例采用单纯腹腔镜胆囊切除术,造影组46例腹腔镜胆囊切除术中采用选择性经胆囊管胆道造影。比较两组患者的手术时间、术中出血量、住院时间、中转剖腹情况以及术中、术后各类并发症的发生情况。结果造影组患者的手术时间、住院时间与常规组比较,差异无统计学意义(P>0.05)。造影组患者术中出血量及中转开腹率显著低于常规组,差异有统计学意义(P<0.05)。造影组患者胆道损伤、胆总管残余结石及胆囊切除术后综合征的发生率均明显低于常规组患者,差异有统计学意义(P<0.05)。造影组患者切口感染、腹腔感染及胆道感染的发生率与常规组比较,差异无统计学意义(P>0.05)。结论将选择性经胆囊管胆道造影应用于腹腔镜胆囊切除术中,有助于胆总管结石的发现及取出,减少对胆道损伤及术后并发症的发生,降低术中转开腹的发生,从而提高手术质量及疾病治愈率,且并不增加术后感染机会,值得临床推广应用。

Objective To analyze the effect of selective cholangiography in the emergency laparoscopic cholecystectomy.Methods From April 2013 to April 2016, in Beijing Chuiyangliu Hospital, the clinical data of 128 patinets with cholecystitis cute attack underwent emergency laparoscopic cholecystectomy were retrospectively analyzed, they were divided into two groups according to the operation mode, 82 cases in the convention group were treated with simple laparoscopic cholecystectomy, and 46 cases in radiography group were treated with selective cholangiography of cystic duct during the laparoscopic cholecystectomy. The time of operation, intra-operative blood soss, hospital stays, situation of transfer laparotomy, the incidence of intraoperative and postoperative complications of two groups were compared. Results The time of operation and hospital stays in the two groups were compared, the differences were not statistically significant（P 〉 0.05）. The intraoperatve blood loss and rate of transfer laparotomy in the radiography group were significantly less than those of the convention group, the differences were statistically significant（P 〈 0.05）. The incidence of bile duct injury, residual stones of common bile duct stones and gallbladder resection syndrome of the radiography group were significantly lower than those of the convention group, the differences were statistically significant（P 〈 0.05）. The incidence of incision infection, celiac infection and biliary infection of the two groups were compared, the differences were not statistically significant（P 〉 0.05）. Conclusion The application of cholangiography through cystic duct in laparoscopic cholecystectomy is contribute to finding and removing of common bile duct stones, reduce the bile duct injury and postoperative complications, reduce the incidence of transfer laparotomy, improve operation quality and cure rate of disease, and it does not increase the chance of postoperative infection, it is worthy of clinical popularization and application.