| 摘要: |
| ［摘要］ 目的 探讨经胆囊管胆道镜胆总管探查及取石术的有效方法和适应证。方法 选择疑有胆总管结石及有探查指征的61例患者，在胆囊切除时将胆囊管残端稍为留长，以便于提取牵拉。选用OLYMPUS-P20型胆道镜沿胆囊管轻柔插入，如胆囊管尚不够粗，可先予扩张。胆道镜发现结石后，以取石网篮套取拉出。如结石较大难以通过胆囊管者则常规切开胆总管取石。镜检及取石结束后经胆囊管注入庆大霉素8～16万单位后予胆囊管结扎。结果 29例在胆总管下端发现结石，其中24例在胆道镜下予取石网套取除，5例因结石较大常规切开胆总管取除，32例未发现结石。61例患者术后均恢复良好，术后无胆漏、胆道出血发生。B超随访或术后T管造影无结石残留。结论 经胆囊管行胆总管探查及取石术是一项较为有效的微创技术，可使部分患者减少创伤，缩短治疗周期，但其主要适用于胆总管继发性小结石同时伴胆囊管增粗者。 |
| 关键词: 胆道镜 胆总管 胆囊管 结石 |
| DOI：10.3969/j.issn.1674-3806.2011.04.14 |
| 分类号:R 575.7 |
| 基金项目: |
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| Common bile duct exploration and lithotomy through cystic duct under choledochoscope |
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MA Li-lin, ZHU Jian-wei, LU Li-ping, et al.
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Department of General Surgery, the Affiliated Hospital of Nantong University, Jiangsu 226001, China
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| Abstract: |
| ［Abstract］ Objective To investigate the methods and indications of common bile duct exploration and lithotomy through cystic duct under choledochoscope. Methods Sixty-one patients with suspected common bile duct calculi or other exploration indicator were selected. Cystic duct was retained length enough for facilitating following procedure, OLYMPUS-P20 choledochoscope was gently inserted into cystic duct (Cystic duct would be explanted if it was not big enough in diameters). Calculus was pulled out when it was found through choledochoscope. The huge calculus bigger than cystic duct in diameter that made them difficult to pass it would be removed by routine common bile duct exploration procedure. Cystic duct was ligated after injection of 80 000～160 000 units of gentamicin through it at the end of operation. Results In 29 patients with calculi at the distal of the common bile duct, calculi were removed through cystic duct under choledochoscope in 24 patients, the calculi in other 5 patients was removed by routine common bile duct exploration procedure, no calculus was found in the remain 32 patients. Sixty-one patients recovered well and quickly after operation.No postoperative bile leakage and biliary tract bleeding occurred after operation in all sixty-one patients. Post-operation ultrasonograph and T tube imaging check concerned no retain calculus in common bile ducts. Conclusion Common bile duct exploration and lithotomy through cystic duct under choledochoscope is a effective technique with less operation trauma, quickly recover and can decrease in-hospital days in patients with suspected common bile duct calculi. At present, it is mainly applied to secondary small calculi in common bile duct with distention cystic duct. |
| Key words: Choledochoscope Common bile duct Cystic duct Calculus |
