胆总管汇合部微切开探查取石术的优越性.pdfVIP

· 1 1 4 · 中华普通外科学文献（电子版）2013 年 4 月第 7 卷第 2 期 Chin Arch Gen Surg（Electronic Edition)，April 2013，Vol 7，No.2 ·论著 · 胆总管汇合部微切开探查取石术的优越性 陈剑　缪刚　李尧　贺修文　叶晓华　陈敏　韦军民 　　【摘要】　目的　探讨汇合部胆道微切开取石术治疗胆管结石的优越性，并进一步明确胆 道取石中放置 T 管的适用范围。方法　针对 85 例实施胆道微切开手术的患者，运用 MRCP（磁 共振胰胆管造影）、Advantage Workstation AW4.2-07sdc 软件、术中胆道镜成像系统、图画等方 法，对胆道微切开取石的适用范围进行了系统性地讨论。结果　绝大多数胆管结石患者的胆总管 宽度在 8 mm 以上，而胆管的宽度可能与结石的大小和多少相关。胆管宽度≥ 11 mm（16 例）的 MRCP 结石影像面积（mm2 ）较胆管宽度＜ 11 mm（14 例）的 MRCP 结石影像面积显著性增大 （148±67 47±31，P 0.05）。对于胆总管下段非游离、多发、结构致密结石，由于一次性 vs 彻底取石困难，需留置 T 管引流备二次胆道镜检查。结论　胆道微切开取石技术可避免大多数不 必要的术后 T 管处理，尤其适合于早期诊断的胆管结石。T 管引流多仅限于一次性彻底取石困难、 病情复杂的患者。　 　　【关键词】　胆管结石；微切开；T 管引流；MRCP * Superiority of mini-incision technique in bile-duct stone removal surgery CHEN Jian , MIAO Gang, * LI Yao, HE Xiu-wen, YE Xiao-hua, CHEN Min, WEI Jun-min. Department of General Surgery, Beijing Hospital, Beijing 100730, China Corresponding author: CHEN Jian, Email: chendaoxian@ 　　 To discuss the superiority of bile duct mini-incision(BDM) technique 【Abstract】　Objective during stone removal surgery in choledocholithiasis, and to further clarify the indications of T-tube insertion during the surgery. Methods A total of 85 BDM operations were performed. Magnetic resonance cholangiopancreatography(MRCP), Advantage Workstation AW4.2-07sdc software, choledochoscope imaging system, and illustrations were used to clarify the indications of BDM technique in stone removal procedure. Results The width of common bile duct (CBD) was usually more than 8mm in our choledocholithiasis cases, and the width was probably related to the number and size of the stones. In the cases with CBD width over 11 mm (16 cases), the