选择性术中胆道造影在腹腔镜胆囊切除术中的应用

胆囊切除术中胆道造影(IOC)是常规应用还是选择性应用的争议,从开腹胆囊切除(OC)时代一直延续到腹腔镜胆囊切除(LC)时代。在LC开展的早期,胆管损伤的发生率较高,由于IOC被认为不仅可以预防结石残留而且可以防止胆管损伤,常规IOC得到了大力提倡。对于选择性IOC能否有效地防止结石残留及IOC对医源性胆管损伤有无预防价值的认识是决定采取常规IOC或选择性IOC的关键。我院自1995年开展LC以来选择性地施行IOC,获得了满意的效果,现报告如下。1　材料和方法1.1　一般资料　1995年6月到1999年4月共行LC815例,其中胆囊结石673例,胆囊息…     

选择性术中胆道造影在腹腔镜胆囊切除术中的应用

我院自2005年3月起在腹腔镜胆囊切除术患者中行选择性术中胆道造影,获得了满意的效果。现报告如下。临床资料1.一般资料:2005年3月至2006年6月共行LC150例,年龄15~78岁,其中男62例,女88例。行腹腔镜下术中造影28例,其中男9例,女19例,年龄20~76岁。2.选择性术中胆道造影的筛选方     

腹腔镜胆囊切除术中胆道造影的价值

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）术中胆道造影的临床价值及适应证。方法2003年1月-2006年1月我院对165例行LC术中经胆囊管胆道造影（intraoperative cholangiography，IOC），根据造影结果指导LC术中操作，调整手术方案。结果165例LC术中经胆囊管胆道造影发现胆囊管变异22例，胆囊管结石12例，合并胆总管结石8例。本组无胆道损伤，避免胆总管阴性探查7例。结论LC术中经胆囊管胆道造影对于预防术中胆道损伤、减少胆总管阴性探查具有重要价值。     

选择性术中胆道造影在腹腔镜胆囊切除术中的应用价值

我院1992年2月至2006年4月间为315例病人行腹腔镜胆囊切除术中胆管造影，有效的预防胆管结石的漏诊，提高胆道疾病的术中诊断率取得了良好的效果，现报道如下。     

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。     

术中胆道造影在腹腔镜胆囊切除术中的应用价值

目的: 探讨降低腹腔镜胆囊切除术后胆总管残留结石发生率的方法.方法: 回顾性分析83例患者的病史、术前B超、生化检查、MRCP及术中胆管造影结果的临床资料.结果:83例中1例术中胆道造影失败;造影成功的82例中,发现合并胆总管结石12例,阳性率为14.6%(12/82).结论: 对于术前怀疑有胆总管结石的患者,应适当放宽术中胆道造影指征,可降低术后胆总管残留结石的发生率.     

术中胆道造影在腹腔镜胆囊切除术中应用价值

目的探讨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在切除胆囊前,常规在C型臂X线下行胆道造影,并及时采集、保存图像,以了解肝外胆管内有无结石存在。若发现结石,继而行中转开腹胆总管探查取石术。结果施行的76例术中胆道造影中,发现胆总管结石5例,其中胆总管下段多发结石2例,胆总管内单发结石2例,胆总管内一长柱状结石1例。5例胆总管结石取出术后均放置T型管,随访T管造影复查,未见结石残留。结论腹腔镜胆囊切除术常规行术中胆道造影可有效地防止胆道结石残留,避免了不必要的胆管探查,减少了胆管损伤和术后并发症的发生,减少了患者的住院费用和住院时间,且术中胆道造影操作简单、迅速、安全,除有禁忌证外,应常规应用术中胆道造影。     

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...     

术中胆道造影在单纯胆囊切除术中的应用价值

对有胆道探查指征病例行术中胆道造影(IOC)可避免胆道阴性探查,降低胆道残石发生率以及减少胆道损伤等.但对单纯胆囊切除病例是否行常规IOC,存在分歧.有学者认为应常规行IOC[1];也有学者认为应选择性行IOC[2,3].为了解IOC在单纯胆囊切除术中的地位和作用,本院对1996年1月至2002年12月之间收治的手术治疗的单纯胆囊结石患者共140例,行IOC,获得满意效果.现报告如下.     

Confirmation of a ``safety zone' by intraoperative cholangiography during laparoscopic cholecystectomy

Background: Creating a safety zone during laparoscopic cholecystectomy is defined as dissection of the cystic duct as close as possible to the gallbladder. Methods: In 29 out of 802 cases in which laparoscopic cholecystectomy was difficult to perform due to uncertainty about the orientation of Calot's triangle, intraoperative cholangiography was performed, using a titanium clip as a marker that designated the safety zone. The distance between the clip and the common hepatic duct or the common bile duct could be determined by evaluation of two intraoperative cholangiograms taken in different orientation. Results: If the clip was located in the safety zone, and was distant from the common hepatic duct or common bile duct, the safety of preparation around the clip was ensured. No complication was encountered in these cases with this method. Eventually, no biliary tract injury was experienced, and the overall conversion rate to open cholecystectomy was only 0.4% (3 of 802 consecutive cases). Conclusions: This method of confirming the safety zone by intraoperative cholangiography is a useful procedure for avoiding inadvertent injury to the biliary tract.     

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.     

Intraoperative cholangiography during laparoscopic cholecystectomy

An audit of routine intraoperative cholangiography in a consecutive series of 496 patients undergoing laparoscopic cholecystectomy has been performed. Cannulation of the cystic duct was possible in 483 patients (97%). The use of portable, digitized C-arm fluorocholangiography was vastly superior to the employment of a mobile x-ray machine and static films in terms of reduced time to carry out the procedure and total abolition of unsatisfactory radiological exposure of the biliary tract. Repeat of the procedure was necessary in 22% of cases when the mobile x-ray equipment was used. Aside from the detection of unsuspected stones in 18 patients (3.9%), routine intra-operative cholangiography identified four patients (0.8%) whose management would undoubtedly have been disadvantaged if intraoperative cholangiography had not been performed.     

Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy

Background The use of intraoperative cholangiography (IOC), routinely rather than selectively, during laparoscopic cholecystectomy (LC) is controversial. Recent findings have shown laparoscopic ultrasound (LUS) to be safe, quick, and effective not only for screening of the bile duct for stones, but also for evaluating the biliary anatomy. This study aimed to evaluate, on the basis of the LC outcome and the cost of LUS and IOC, whether and how much the routine use of LUS would be able to reduce the need for IOC. Methods During LC, LUS was used routinely to screen the bile duct for stones and to evaluate the biliary anatomy, whereas IOC was used selectively only when LUS was unsatisfactory or unsuccessful. Results For 193 (96.5%) of 200 patients, LUS was completed successfully, whereas IOC was needed for 7 patients (3.5%). Bile duct stones were identified in 20 patients (10%). For the detection of bile duct stones, LUS yielded 19 true-positive, 175 true-negative, 0 false-positive, and 1 false-negative results. It had a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.4%. The postoperative complications included bile leaks from the liver bed in two patients and a retained bile duct stone in one patient. If IOC had been used selectively in a traditional manner on the basis of preoperative risk factors, IOC would have been needed for 77 patients (38.5%). The total cost of LUS plus IOC for the current 200 patients was $26,256. The total estimated cost of selective IOC, if it had been performed for the 77 patients, would have been $31,416. Conclusions Routine LUS accurately diagnosed bile duct stones and significantly reduced the need for selective IOC from a potential 38.5% to an actual 3.5% without adversely affecting the outcome of the LC or increasing the overall cost. The routine use of LUS during LC is accurate and cost effective.     

A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy

Indications for intraoperative evaluation of the common bile duct during laparoscopic cholecystectomy are controversial, as is the goal of either anatomic definition or assessing for choledocholithiasis. One hundred twenty-five consecutive patients undergoing laparoscopic cholecystectomy underwent both intraoperative ultrasound and intraoperative cholangiography. Cholangiography required slightly more time to perform; it was more sensitive (92.8% vs 71.4%) but less specific (76.2% vs 100%) for choledocholithiasis than was ultrasound. Ultrasound was somewhat more difficult to perform, and, particularly in the setting of intraabdominal obesity, was often inadequate at providing clear visualization of the intrapancreatic common bile duct. It did not provide the same anatomic definition as an adequate cholangiogram. The overall incidence of choledocholithiasis was 11.2%.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994     

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。     

腹腔镜胆囊切除术中胆道造影的临床意义

目的:探讨术中胆道造影对行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)患者的临床意义。方法:回顾性分析113例因胆囊结石行LC加术中胆道造影患者的情况。结果:113例患者中造影成功110例(成功率97%),发现胆总管结石5例,占4.5%(5/110)。结论:LC加术中胆道造影有利于防止胆道残余结石,对正确判断胆道解剖关系,减少胆道损伤有重要的临床意义。LC加术中胆道造影可常规使用。     

选择性胆道造影在腹腔镜胆囊切除术中的应用

目的探讨腹腔镜胆囊切除术（laparoscopy cholecystectomy,LC）中开展选择性的胆道造影技术及其临床应用价值。方法对98例术中胆道造影患者的临床资料进行回顾性分析。结果同期LC 862例,术中胆道造影98例,造影成功90例,成功率为91.8%。术中发现胆管结石7例,胆管损伤1例,胆道解剖异常2例。结论选择性术中胆道造影操作简便安全,成功率高,显影清晰,可有效降低胆管结石的残余率和胆管损伤的发生率,避免不必要的胆道探查,提高LC手术的安全性。