经胆囊管术中胆道造影的临床应用价值

目的探讨胆囊切除术中有胆总管相对探查指征时经胆囊管行术中胆道造影的临床应用价值。方法回顾性分析术前B型超声检查和术中检查有胆总管探查相对指征的52例患者行术中胆道造影的临床资料。结果52例中阳性6例,假阳性2例,假阴性1例,准确率94.2%。结论经胆囊管术中胆道造影可提高胆道结石诊断率,避免不必要的胆总管切开探查,减少术后残余结石的发生,并能防止胆道损伤,是一种安全、简便的检查方法。

经胆囊管术中胆道造影52例分析

目的 探讨经胆囊管术中胆道造影对胆总管的探查价值。方法 回顾性分析术前B型超声检查和术中检查有胆总管探查相对指征的 5 2例患者术中胆道造影的情况。结果 5 2例中 ,阳性 6例 ,假阳性 2例 ,假阴性 1例 ,准确率 96 %。结论 经胆囊管术中胆道造影可避免不必要的胆总管探查 ,提高胆道结石诊断率 ,避免遗漏胆管结石 ,能防止或了解胆道损伤 ,是一种安全。

经胆囊管术中胆道镜探查胆管76例分析

经胆囊管术中应用胆道镜可避免不必要的胆总管切开探查、T管引流所引起的一系列并发症。我院自2004年3月-2010年2月对76例胆囊切除病人，行开腹经胆囊管胆总管探查术（open transcystic common bilc duct exploration，OTCBDE），取得了满意效果，现报告如下。

How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis.The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.Methods:A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment.According to several pre-operative parameters,141 patients had to supposedly undergo transcystic clearance of the bile duct,while 39 patients had to be treated with the rendezvous technique.All patients were treated with the sequential procedure:first,we tried the transcystic procedure and,if there was a failure,we used a rendezvous technique.We prospectively analysed each group based on a series of variables such as sex,age,operative time,success rate of proposed treatment,conversion rate,post-operative complications and hospital stay.Results:Transcystic clearance was successful in 134 out of 141 patients(95.0%),while 2 patients needed to undergo a laparo-endoscopy procedure(failure).Thirty-five out of 39 patients(89.7%)obtained common bile-duct(CBD)clearance through the rendezvous technique,while 1 patient obtained clean-up through the simple transcystic procedure(failure).Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5%and 7.7%,respectively.Post-operative complications showed similar percentages for both procedures.However,the surgical time turned out to be longer for the rendezvous technique.Conclusions:The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94%of the cases utilizing a surgical technique selected according to the patient’s case history.The pre-operative parameters,such as jaundice,CBD diameters and stone diameters,have certified their reliability as good predictors of the most suitable procedure to follow.