具有相对探查指征的胆总管术中处理对策

Management of patients with relative indication of common bile duct exploration during cholecystectomy

目的 :探讨具有相对探查指征的胆总管术中处理方法 ,提高胆总管切开探查的准确性。方法 :对 112例具有胆总管相对探查指征的胆囊结石患者的临床资料进行分析 ,其中术中经胆囊管胆道造影 2 8例 ;经胆囊管纤维胆道镜检查 2 7例 ;常规切开胆总管探查 5 7例。结果 :胆道造影 2 8例中 ,有 4例胆总管结石 ,3例肝胰壶腹括约肌狭窄 ,2 1例阴性 ;胆道镜检查 2 7例 ,发现 17例胆总管结石且均经胆囊管取石成功 ,10例阴性 ;两种检查阴性率 5 6 .4 % (31/ 5 5 ) ,胆总管未切开 4 8例 ,术后平均 9天出院。常规探查 5 7例中 ,均予切开胆总管 ,36例阴性 ,阴性率 6 3.2 % ,且术中留置T型管外引流 ,平均 15天出院。结论 :对具有胆总管相对探查指征的患者 ,术中经胆囊管胆道造影 ,或纤维胆道镜检查 ,可避免切开许多不该切开的胆总管 ,降低胆总管切开探查阴性率 ,从而减少手术并发症 ,缩短住院时间。

Objective:To investigate the intraoperative management of patients with relative indication of common bile duct exploration(CBDE) so as to increase the accuracy of CBDE.Methods:The clinical data of 112 patients with relative indication of CBDE was analyzed,cholangiography was performed in 28 cases,choledochoscopy in 27 cases and routine CBD exploration in 57 patients.Results:In the 28 cases who underwent cholangiography,4 had CBD stones,3 had Oddi sphincter muscle stenosis and 21 proved negative results.In the 27 cases receiving choledochoscopy,17 were found to have CBD stones which were successfully got out through cystic duct and 10 cases had negative results.The negative rate of both tests was 56.4%(31/55).The 48 cases having no incision of CBD had an average postoperative hospital stay of 9 days.In the same time 57 cases with relative indication of CBDE were routinely incised for CBD and discharged 15 days after operation on the average in 36 cases.The results were negative and the negative rate was 63.2%.Conclusions:During the cholecystectomy,the patients presenting with relative indication of CBDE should be performed cholangiography and/or choledochoscopy to avoid,blind incision of CBD.By doing so,the negative rate of CBDE and operative complications can be decreased,and the hospital stay shortened.