LC中选择性行经胆囊管造影的临床应用

目的评价选择性行经胆囊管胆道造影在腹腔镜胆囊切除（LC）术中的应用价值。方法回顾性分析113例在LC术中选择性行经胆囊管造影的患者的临床资料。结果术中造影成功108例,成功率为95．6％,术中发现胆总管结石16例,胆管变异3例,胆管损伤1例。结论在LC术中行选择性经胆囊管造影,可协助确诊胆道结石残留,避免不必要的胆道阴性探查,并可避免和发现胆管损伤,对于提高腹腔镜胆囊切除术的质量和安全性具有重要临床价值。     

术中胆道造影在腹腔镜胆囊切除术中的应用

目的 :探讨术中胆道造影在腹腔镜胆囊切除术 (LC)中应用的临床价值。方法 :回顾总结 6 7例LC术中行胆道造影的技术要点。结果 :LC术中行胆道造影 6 7例 ,发现胆管结石 19例 ,近端胆囊管小结石 1例 ,乳头部狭窄 1例 ,胆道畸形 2例 ,假阳性 3例 ,准确率 95 5 %。结论 :有选择的在LC中胆道造影可以避免胆管残留结石及胆囊管残株结石 ,减少不必要的胆管阴性探查 ,发现乳头部狭窄 ,辨明胆道解剖 ,避免胆道损伤。     

选择性术中胆道造影在腹腔镜胆囊切除术中的价值

目的:探讨选择性术中胆道造影在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:回顾分析231例术前诊断为胆囊结石、胆囊息肉样病变的患者于LC术中经胆道造影发现胆道病变、变异的临床资料。结果:225例造影成功,成功率97.4%。术中胆道造影发现胆囊管残石3例,胆总管结石12例,胆管损伤4例,胰胆管汇合异常14例,胆囊管异常开口12例,右侧副肝管4例,胆总管憩室1例,十二指肠乳头旁憩室6例,Mirizzi综合征5例,右肝内钙化灶2例。结论:LC术中行胆道造影不仅能发现术前未确诊的胆总管结石、胆囊管结石,而且利于胆管变异、胰胆管汇合异常及乳头旁憩室的诊断。     

术中胰胆造影在腹腔镜胆囊切除术中的应用价值

目的 探讨腹腔镜胆囊切除术中行胆道造影的适应证、方法及应用价值.方法 回顾总结分析82例LC术中胆道造影的临床资料.结果 82例中71例未发现异常,8例发现胆总管结石,其中3例伴有胆总管末端狭窄;2例未发现胆管结石,但显示胆总管末端狭窄;1例发现右剐肝管损伤.结论 术中行胆道造影,对防止LC术中遗漏胆管结石和及早发现胆...     

腹腔镜胆囊切除术中胆道造影的临床应用

目的 探讨选择性术中胆道造影在腹腔镜胆囊切除术中的临床应用价值。方法 回顾性分析125例经腹腔镜胆囊切除术中选择性经胆囊管插管行胆道造影的临床资料。结果 术中造影发现胆总管结石22例，胆总管下端狭窄4例，胆管损伤1例，副肝管2例。结论 腹腔镜胆囊切除术中选择性经胆囊管行胆道造影对降低胆管结石的残留，减少不必要的胆管阴性探查，辨明胆道解剖，避免及发现胆管损伤，提高腹腔镜胆囊切除术的质量和安全性有重要价值。     

选择性术中胆道造影在腹腔镜胆囊切除术中的应用

目的 探讨术中胆道造影在腹腔镜胆囊切除术（LC）中的应用价值。方法 对105例LC术中经胆囊管胆道造影患者临床资料进行分析。结果 105例中均插管成功，并完成术中胆道造影。其中发现胆总管结石15例，胆总管下段乳头部狭窄5例，假阳性l例。结论 LC术中胆道造影操作简便安全，胆道结构显影清晰，成功率高，能有效发现胆道结石，降低胆管损伤发生率。     

选择性胆道造影在腹腔镜胆囊切除术中的应用体会

目的 评价选择性术中胆道造影在腹腔镜胆囊切除术中的应用价值。方法 腹腔镜胆囊切除术中经胆囊管插管行胆道造影共88例。结果 造影均成功。术中造影发现胆总管结石5例,无胆管损伤。结论 选择性术中胆道造影,对降低胆总管结石残留,避免胆管损伤,提高腹腔镜胆囊切除术的疗效有重要价值。     

常规/选择性胆道造影在腹腔镜胆囊切除术中的应用研究

目的 探讨腹腔镜胆囊切除术中常规应用和选择性应用胆道造影的效果.方法 常规术中胆道造影组1 520例,选择性术中胆道造影组457例.采用自制造影器或输液针头完成术中造影,比较2组的造影时间、造影成功率、胆总管结石发现率、胆管解剖变异发现率、医源性胆管损伤发生率、中转开腹率以及术后住院时间.结果 2组病例在造影时间、造影成功率、中转开腹率以及术后住院时间方面的差异均无统计学意义(P＞0.05);选择性造影组的胆总管结石发现率、胆管解剖变异发现率以及医源性胆管损伤发生率均高于常规造影组(28.25％比13.43％,10.71％比7.43％,2.05％比1.02％,P＜0.05).结论 在开展腹腔镜胆囊切除术的早期,应采用常规术中胆道造影,以避免医源性胆管损伤的发生和胆总管结石残留.待技术纯熟以后,可以选择性地进行术中胆道造影.     

腹腔镜胆囊切除术中胆囊管切开探查的临床意义

目的 探讨腹腔镜胆囊切除术(LC)中胆囊管切开探查的临床意义.方法 :回顾分析1722例LC病例中306例胆囊管切开探查情况.结果 :胆囊管切开探查中,发现胆囊管结石109例;经胆囊管切口行胆道造影46例,发现胆总管结石16例(其中胆囊管、胆总管均有结石者10例),发现胆管损伤1例,胆管异常3例.总阳性发现率为38.9%.结论 :LC病例选择性胆囊管切开探查,可为术中胆道造影检查、胆道镜取石提供途径,可减少并发症,提高LC质量.     

腹腔镜胆囊切除术中经胆囊管胆道造影52例临床分析

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中选择性经胆囊管胆道造影的应用价值。方法回顾性分析52例LC中经胆囊管胆道造影者的临床资料。结果除1例患者因胆囊管过细,过短及急性胆囊炎致Calot三角粘连、解剖不清而致插管失败外,余51例(98.1%)均插管成功。术中胆道造影发现胆总管结石4例,其中3例术中经纤维胆道镜取石成功,1例因结石嵌顿中转开腹行胆总管切开取石;胆囊管过长或变异3例,在造影片指导下成功完成LC;胆道损伤2例,转开腹行胆总管修补,T管引流术后痊愈出院,术后随访未见明显手术相关并发症。结论 LC术中选择性经胆囊管胆道造影简单易行,能显著降低胆道结石残留和及时发现胆道损伤等严重并发症,值得推广应用。     

Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy

Background Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. Methods Data from 2,130 consecutive LCs and patients’ follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. Results In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. Conclusion RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.     

腹腔镜胆管造影在胆总管结石误探与漏探中的应用价值

目的 为避免胆总管结石误探和漏探,分析腹腔镜胆管造影在胆管探查中的应用价值.方法 回顾性分析2015年1月至2019年12月完成的230例腹腔镜胆囊切除(LC)、胆总管探查术(LCBDE)患者的临床资料,选取腹腔镜术中胆管造影(intraoperative cholangiography,IOC)的患者41例作为观察组...     

腹腔镜胆囊切除术时胆囊管嵌顿结石的处理

目的　总结腹腔胆囊切除术 (LC)时处理胆囊管结石嵌顿的经验。　方法　 1997年 7月～ 2 0 0 1年 6月 ,5 8例胆囊管结石嵌顿。先行胆囊管切开取石而后术中胆道造影 ,如发现胆总管结石则联合内镜切石或中转开腹。　结果　 5 8例均取石成功。 5 1例行单纯LC。术中胆道造影示胆总管结石 7例 ,5例行LC术中联合内镜下括约肌切开取石 ,2例中转开腹行胆总管切开取石联合T管引流。无严重并发症发生。　结论　几乎所有胆囊管结石嵌顿都可用胆囊管切开取石的方法完成LC ,并结合术中胆道造影 ,如发现胆总管结石可联合内镜括约肌切开取石。     

腹腔镜术中连续胆道造影258例分析

目的 :探讨腹腔镜术中连续胆道造影诊断胆道外科疾病的价值。方法 :对行腹腔镜胆囊切除(LC)、胆道探查 (LCHT)经胆囊、胆囊管、胆总管灌注连续胆道造影并与术前BUS结果进行对照。结果 :胆囊管结石 2 3例均于术中造影证实。胆总管病变 4 2例 ,术中造影确诊 2 9例 ,支持B超诊断 13例 ,B超确诊 12例 ;怀疑胆道结石 3例中 2例排除 ;胆总管肿瘤 4例中 2例经术中造影排除 ;右肝管结石 2例 ,右肝管损伤 1例均排除。结论 :腹腔镜术中连续胆道造影能清晰显示胆道病变 ,防止腹腔镜术中遗漏胆道病变与意外损伤 ,费用低廉 ,易操作 ,无并发症发生     

腹腔镜胆囊切除术中胆道造影的临床探讨

目的 :减少腹腔镜胆囊切除术后胆总管残留结石的发生率。方法 :根据病史及术前B超检查结果 ,对可疑胆总管结石行腹腔镜胆囊切除术中胆道造影 ,明确胆道情况。结果 :同期行LC 6 5 0例 ,术中胆道造影 89例 ,成功 78例 ,成功率 87 6 4% ,术中发现胆总管结石 19例 ,占同期LC总数的 2 92 %。结论 :术中胆道造影成功率高 ,显像清晰 ,是一种良好的胆道检查方法 ,为腹腔镜胆囊切除术的成功奠定了基础 ,同时也使患者避免了二次手术的痛苦     

十二指肠镜、腹腔镜序贯治疗胆石症2 248例分析

目的探讨十二指肠镜、腹腔镜序贯性诊治胆石症的价值. 方法回顾性分析2000年1月～2004年12月采用十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症2 248例的临床资料. 结果确诊胆囊结石1 817例,胆囊结石合并胆总管结石431例.B超诊断为胆囊结石2 021例中,行术前ERCP 690例,发现胆总管结石213例;术中胆道造影(IOC)85例,发现胆总管结石10例;腹腔镜胆囊切除(LC)术后胆总管残余结石6例,并经EST治愈.B超诊断胆囊结石合并胆总管结石227例中,ERCP证实胆总管结石202例.行LC 1 817例,EST LC 395例,LBDE 36例(其中胆管一期缝合26例,T管引流10例).全组中转开腹28例(1.2%),并发症52例(2.3%). 结论十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症,体现了内镜、腔镜联合应用的优势,术后残余结石率低,微创治疗成功率高.     

Value and consequences of routine intraoperative cholangiography during cholecystectomy

Since the introduction of laparoscopic cholecystectomy (LC), an increase in accidental common bile duct (CBD) injuries of up to 1.2-1.6% has been reported. In the present prospective study of 1,710 patients undergoing cholecystectomy (1,241 LC procedures and 469 open cholecystectomies [OC]), we tested the predicative value of routine intraoperative cholangiography (IOC). The IOC was feasible in 92.4% of the cases in the LC group and in 83% of cases in the OC group and presented a complete depiction of the extrahepatic bile system in 98.3%. Anatomic variations of the bile duct system, which influenced the operative management, were found in 13.2% of cases (13.4% LC versus 12.8% OC). In 2.5% of the patients, preoperatively undetected CBD stones were also found. Method-specific complications did not occur in any of the patients. Additionally, in a controlled subgroup analysis of 163 patients, we evaluated preoperative intravenous cholangiography (IVC) and IOC. Intravenous cholangiography showed only 72.4% of the operation-relevant anatomic variations (vs. 100% by IOC); in 6.1% of the cases, there were reactions to the dye (vs. none in IOC), and in only 28.6% of the patients, CBD stones were detected (vs. 71.4% IOC). There were four bile duct injuries (0.29%) during LC and two (0.4%) during OC. All injuries were detected intraoperatively and fixed in the same setting without postoperative complications. In conclusion, we recommend the use of routine IOC during cholecystectomy. By this technique, anatomic variations of the bile duct system will be visualized and therefore accidental injuries will be avoided.     

腹腔镜胆囊切除术中经胆囊管胆道造影的临床意义

目的 探讨腹腔镜胆囊切除术中行经胆囊管胆道造影对隐匿性胆总管结石及医源性胆管损伤诊断的临床意义.方法 回顾性分析341例腹腔镜胆囊切除术患者的临床资料,其中137例术中行经胆囊管胆道造影,207例未行造影.结果 137例行术中胆道造影者,术中发现胆总管结石11例（8.03％）,胆管损伤1例（0.72％）;术后随访3～6个月发现胆总管残余结石4例（2.92％）,未发现胆管损伤.204例未行术中胆道造影者,术中发现胆总管结石5例（2.45％）,术中未发现胆管损伤;术后随访3～6个月发现胆总管残余结石18例（8.82％）,胆管损伤2例（0.98％）.结论 腹腔镜胆囊切除术中经胆囊管胆道造影操作安全、快速、无创,可提高胆总管结石诊断的敏感度,及时发现胆管损伤,降低胆总管残余结石发生率,避免不必要的胆道探查.     

腹腔镜超声检查在胆囊切除胆道探查术中的应用

目的：探讨腹腔镜超声检查在胆囊切除胆道探查术中的应用价值。方法：腹腔镜下对126例腹腔镜胆囊切除胆道探查术患者常规行腹腔镜超声检查,并选择其中30例行术中胆管造影。与腹腔镜超声检查行对比研究。结果：腹腔镜超声检查平均时间17min,对胆道系统和血管系统扫描结果显示：胆囊和门静脉100％显像,肝胆管,胆总管97％显像,胆总管未端85％显像,腹腔镜超声检查和术中胆管造影对比结果显未腹腔镜超声检查的胆总管检查成功率及胆管结石的敏感性,特异性及总诊断成功率均优于术中胆管造(影（分别为97％,82％,97％,98％和80％,75％,95％,95％）。结论：腹腔镜超声检查的应用有助于判断胆道系统的解剖结构,防止发生胆管损伤,有助于发现或排除肝内外胆管结石,为胆管造影及胆道探查术提供重要指标。降低了胆道残石和阴性胆道探查术的发生率。