摘要
目的探讨胆囊切除术后肝外胆管残余结石的预防。方法回顾分析7921例胆石症患者的临床资料。将磁共振胰胆管成像(magneticresonancecholangiopancreatography,MRCP)作为胆石症术前常规检查,术中疑有胆管结石者及时行经胆囊管造影或经胆囊管胆道镜探查,术中尽量避免医源性胆管结石残留。结果本组7921例胆石症患者,经MRCP检查及术中造影、胆道镜探查发现B超漏诊胆管结石152例,仅发生3例胆管结石残余,明显低于国外同类报道。结论MRCP可作为胆囊切除术前常规辅助检查,能有效提高胆总管下端结石的确诊率。术中采取经胆囊管造影、经胆囊管胆道镜探查以及提高术者操作技巧等措施,可明显地减少胆囊切除术后肝外胆管残余结石的发生率。
Objective To explore the good methods for the prevention of residual stones in extrahepatic bile ducts after cholecystectomy. Methods MRCP was considered as routine examination before operation; intraoperative cholangiography or choledochoscopy through cystic duct was carried out if choledolith was suspected during operation; the iatrogenic residual stones in bile duct were avoided during operation as far as possible by promoting surgeons＇ operating skill. Results One hundred and fifty-two cases of calculi of bile duct out of 7 921 cases of cholelithiasis were miss diagnosed by B ultrasound, preoperative examination of MRCP or intra-operative cholangiography, or by choledochoscopy through cystic duct. There were only 3 cases of residual stones after operation out of 152 cases. The rate of residual stones was lower than that in home and abroad reports. Conclusion MRCP can be considered as routine preoperative examination, which can efficaciously raise the diagnostic rate in the lower end of extrahepatic bile ducts stones. Intra-operative cholangiography, intra-operative choledochoscopy and promoting surgeons＇ operating skill can obviously lower the rate of residual stones in extrahepatic bile ducts after cholecystectomy.
出处
《肝胆胰外科杂志》
CAS
2007年第4期240-241,共2页
Journal of Hepatopancreatobiliary Surgery
关键词
胆管残余结石
胆囊切除术
胆石症
预防
影像检查
磁共振成像
residual stones of bile duct
cholecystectomy
cholelithiasis
prevention
image examination
magnetic resonance imaging
