核磁共振胰胆管水成像对腹腔镜胆囊切除术的临床研究.docVIP

精品论文 参考文献 核磁共振胰胆管水成像对腹腔镜胆囊切除术的临床研究 崔保刚（河南省安阳市人民医院放射科 455000） 　　【摘要】目的：探讨核磁共振胰胆管水成像（MRCP）术前对腹腔镜胆囊切除术（LC）及术后对胆囊切除综合征（PCS）的临床价值。方法：LC术前对患者进行MRCP检查，确诊胆囊结石患者60例，术后6个月～2年对这些患者再行MRCP以诊断胆囊切除综合征。结果：术前经MRCP检查发现结石60例，部分患者合并有Mirizzi综合征、胆总管狭窄、胆道解剖学变异、布加综合征，均由手术证实；术后6个月～2年发生PCS者11例，均经磁共振胰胆管水成像检查明确病因。结论：术前MRCP利于正确选择PCS术式，减少术中胆道损伤及术后胆总管残余结石的发生率，术后MRCP是对LC作出明确病因学诊断的有效手段。 　　【关键词】核磁共振胰胆管水成像 腹腔镜胆囊切除术 胆囊切除综合征 　　【中图分类号】R445 【文献标识码】A 【文章编号】1672-5085（2013）46-0023-01 　　【Abstract】Objective:To evaluate the preoperative and postoperative clinical value of magnetic resonance cholangiopancreatography (MRCP) to laparoscopic cholecystectomy.Methods:60 patients with gallstones were diagnosed by MRCP examination before LC surgery，another MRCP was performed on these patients 6 months to 2 years after LC to analyze cholecystectomy syndrome.Results:some of the 60 patients with gallstones complicated with Mirizzi syndrome,common bile duct stenosis, biliary anatomy variation and Budd-Chiari syndrome,and it was confirmed by surgery;11 patients suffered from PCS 6 months to 2 years after LC,specific cause of PCS Were confirmed through MRCP.Conclusion:Preoperative MRCP is beneficial for selecting the correct PCS surgical approach,reducing intraoperative bile duct injury and reducing postoperative incidence of bile duct residual stones.Postoperative MRCP is an effective means making a clear etiology diagnosis to PCS. 　　【Key words】magnetic resonance cholangiopancreatography laparoscopic cholecystectomy cholecystectomy syndrome 　　胆囊结石是普外科的常见病、多发病，近年来，随着人们生活水平的不断提高，其发病率呈明显增高趋势，腹腔镜胆囊切除术(LC)作为胆囊结石的首选手术方式及治疗胆囊结石的“金标准”术式，要求术前明确结石的部位、有无胆总管结石、胆道解剖情况以及有无胆囊管畸形[1]，从而正确选择手术方式、避免术中对胆道的损伤及术后减少胆道综合征的发生，而核磁共振胰胆管水成像（MRCP）可清晰地显示肝内外胆道结构[2]，能够充分满足LC的要求。现将在我院采取LC前及术后均行MRCP检查的60例患者的临床资料报告如下： 　　1 一般资料 　　本组60例患者中男性患者38例，女性患者22例，年龄29～68岁，平均年龄42岁。主要临床症状为不同程度的腹部隐痛，消化不良，黄疸，实验室检查发现总胆红素、直接胆红素、AKP升高等肝功能异常者24例。既往病史：有一过性黄疸者11例，有胆绞痛史者7例，有胆源性胰腺炎者5例，院外服用“排石药”者3例。术后6个月～2年再行MRCP检查。