胆囊切除术中经胆囊管造影1569例临床分析.DOCVIP

临床医学论文-胆囊切除术中经胆囊管造影1569例临床分析 【摘要】? 目的? 探讨经胆囊管造影在单纯性胆囊切除术中的价值。方法? 回顾分析本院在1991年1月～2004年12月间1569例单纯性胆囊切除术中常规经胆囊管造影胆管结石的发生率。结果? 1023例无胆总管探查指征，经术中胆囊管造影51例，阳性49例，经探查证实有结石，546例有胆总管相对探查指征，经胆囊管造影158例阳性，151例探查证实。结论? 单纯性胆囊切除术中常规经胆囊管造影可发现隐匿性胆总管结石，能有效减少胆管残余结石，减少胆道损伤。??? ??? 【关键词】? 胆道造影；胆囊切除??? ??? Analysis of 1569 cases with cholangiography in simple cholecystectomy?????????? 【Abstract】? Objective? To investigate the value of cholangiography through cystic duct in simple cholecystectomy.Methods? To analyse retrospectively the rate of calculus of bile duct found through routinal cholangiography in the 1569 cases of simple cholecystectomy from January 1991 to December 2004.Results? Within 1023 cases without indication of exploration of common bile duct，49 cases were found stones in the common duct among 51 cholangiography，positive cases;while within 546 cases with relative indication，158 cholangiography positive and 151were confirmed with calculus.Conclusion? Routinal cholangiography through cystic duct in the simple cholecystectomy can find latent stone in the common duct，then reduce residual stone effectively and lessen biliary duct injury.??? ??? 【Key words】? cholangiography;cholecystectomy??? ??? 单纯性胆囊切除术中，经胆囊管造影是胆总管切开探查前常用的胆道造影方法，对了解胆管解剖形态有无变异，预防医源性损伤起很大的作用，对是否切开胆总管探查可提供权威性意见。本院单纯性胆囊切除术中常规经胆囊管造影。本文旨在回顾性分析本院1991年1月～2004年12月间1569例单纯性胆囊切除术中经胆囊管造影的临床意义。??? ??? 1? 资料与方法??? ??? 1.1? 一般资料? 本组共1569例患者，男508例，女1061例，年龄20～86岁，病程1个月～25年，本组所有病例术前均经实验室检查无黄疸，经B超证实无胆总管结石或其他病变，546例有胆总管探查指征，术中及病史中提供如下情况之一者被定义为相对指征；黄疸史或胰腺炎史，胆囊多枚小结石；胆总管壁轻度增厚；胆囊萎缩且胆囊管扩大；肝脏局限性萎缩。??? ??? 1.2? 方法? 经腹后常规探查，解剖胆囊三角，暴露胆囊管，明确管内无细小结石后结扎，胆总管暴露不理想则结扎近端，切开胆囊管插入细塑料管1.0cm进行造影，胆总管显露满意则逆行切除胆囊后，保留胆囊管残端1.0cm置入细塑料管2.0cm造影，造影剂为30％泛影葡胺20ml。??? ??? 2? 结果??? ??? 1023例无胆总管探查指征患者，经胆囊管造影有充盈缺损51例(4.99％)，胆总管切开探查，证实为胆总管结石49例，假阳性率3.92％。546例有胆总管相对探查指征患者，经胆囊管造影有充盈缺损158例(28.94％)，胆总管切开探查并结合胆道镜检，证实胆总管或肝内胆管结石151例，假阳性率4.43％，本组术中均无医源性胆管损伤发生。??? ??? 3? 讨论??? ??? 单纯性胆囊切除术中经胆囊管造影可发现隐匿性胆总管结石。文献报道术前毫无症状且意想不到的隐匿性胆石症高达14％［1］，目前临床用于检查