摘要
目的探讨亚影像胆管结石的临床意义和腹腔镜下经胆囊管胆道镜探查在治疗急性胆囊炎合并亚影像胆管结石中的作用。方法回顾性分析2015年2月至2017年11月13例行腹腔镜下经胆囊管胆道镜探查的急性胆囊炎合并亚影像胆总管结石患者的临床资料。结果男8例,女5例;年龄39～76岁,平均59. 5岁。所有患者均为急诊入院;入院时均伴有发热、畏寒,腹痛,一过性黄疸等临床症状。13例术前胆红素正常,彩超或CT、磁共振/磁共振胆胰管成像(MRI/MRCP)等影像检查提示急性胆囊炎、胆囊结石,但均未发现胆总管结石,也无胆管扩张。13例均在腹腔镜下成功完成手术,术中行腹腔镜胆囊切除联合经胆囊管胆道镜检查,所有病例均发现存在胆管结石(即亚影像胆管结石),其中小结石8例,浑浊泥沙样结石5例。经胆囊管胆道镜网篮取石3例;胆总管切开取石T管引流术2例;行经胆囊管汇入部微切开取石,一期缝合3例;另5例胆管内为浑浊泥沙样结石,行胆道镜下胆总管冲洗取石,单纯胆囊切除。所有患者术后恢复顺利,住院期间无出血、黄疸、胆漏、感染等并发症。术后彩超、MRI/MRCP等影像学复查未发现胆管异常。结论亚影像胆管结石应引起临床重视;对于合并亚影像胆管结石的急性胆囊炎患者,行腹腔镜下经胆囊管胆道镜探查,能及时发现并妥善处理潜在的胆总管结石,避免再次手术或术后ERCP/EST等有创治疗,具有积极意义。
Objective To investigate the clinical significance of sub-imaging cholangiolithiasis and the effect of laparoscopic choledochoscopy through cystic duct in the treatment of acute cholecystitis with sub-imaging cholangiolithiasis.Methods The clinical data of 13 patients acute cholecystitis with sub-imaging cholangiolithiasis who received laparoscopic choledochoscopy through cystic duct from February 2015 to November 2017 were analyzed retrospectively. Results There were 8 males and 5 females in all the patients,aging from 39 to 76（mean 59. 5 years old）. All patients were admitted to the hospital in emergency,accompanied by fever,chills,abdominal pain,transient jaundice and other clinical symptoms. All the 13 patients had normal bilirubin before operation,and examinations of color Doppler ultrasond,CT,magnetic resonance imaging/cholangiopancreatography（MRI/MRCP） suggested acute cholecystitis and gallstones without common bile duct stones or bile duct dilatation. All 13 cases were successfully performed laparoscopic cholecystectomy combined with choledochoscopy exploration. Biliary duct stones（sub-imaging cholangiolithiasis） were found in all the 13 cases,including 8 cases of small stones and 5 cases of turbid and sediment-like stones. Choledochoscopic basket lithotripsy was performed in 3 cases,and choledocholithotomy and T-tube drainage in 2 cases,while microincision through the cystic duct and primary suture were performed in 3 cases and five cases of intrahepatic choledocholithiasis were treated by choledochoscope common bile duct drainage and cholecystectomy. All patients recovered well without complications such as bleeding,jaundice,bile leakage,infection and so on. Postoperative color Doppler ultrasound,MRI/MRCP and other imaging examination showed no bile duct abnormalities. Conclusions Sub-imaging cholangiolithiasis should be emphasized clinically. For patients with acute cholecystitis complicated with sub-imaging cholangiolithiasis,laparoscopic choledochoscopy through cystic duct could detect an
作者
宋研
禹亚彬
祁付珍
徐建波
SONG Yan;YU Ya-bin;QI Fu-zhen;XU Jian-bo(Department of Hepatobiliary Surgery,The Affiliated Huaian No.1 People＇s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China)
出处
《中国临床研究》
CAS
2018年第10期1368-1371,共4页
Chinese Journal of Clinical Research
关键词
腹腔镜
胆道镜
胆囊管
胆囊切除
胆总管结石
胆囊炎
急性
亚影像胆管结石
Laparoscope
Choledochoscope
Cystic duct
Cholecystectomy
Choledocholithiasis
Cholecystitis,acute
Sub-imaging cholangiolithiasis
