摘要
目的探讨内镜下十二指肠乳头括约肌切开术（endoscopic sphineterotomy，EST）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗胆囊合并胆总管结石术中经鼻胆引流管（endoscopic nasobiliary drainage，ENBD）胆道造影的价值。方法EST处理胆总管结石并放置ENBD管，在LC术中经ENBD管行胆道造影。结果46例术中经ENBD胆道造影均成功，造影时间5—15min，平均8．2min。术中经ENBD管胆道造影发现胆囊脱落至胆总管形成胆总管继发结石4例，其中2例术中再次内镜取出结石，2例结石直径〈3mm术中未处理，术后随访未见胆管结石及胆管炎发生。43例随访6—36个月，平均22个月，未发现胆总管再发结石及胆道逆行感染。结论两镜联合治疗胆囊结石合并胆总管结石，术中经ENBD胆道造影可及时发现并通过术中内镜及时处理继发性胆总管结石，减少术后胆管残余结石的发生。
Objective To discuss the value of intraoperative transnasal cholangiography in endoscopic sphincterotomy （EST） combined with laparoscopic cholecystectomy （LC） for treating cholelithiasis complicated with choledocholithiasis. Methods The EST was carried out to treat common bile duct stones and to conduct the endoscopic nasobiliary drainage （ ENBD）. During the LC the cholangiography was performed by way of ENBD. Results Intraoperative cholangiography was successfully completed in all 46 cases, with a cholangiography time of 5 - 15 min （ mean, 8.2 min）. Secondary common duct stones migrated from the gallbladder were found by cholangiography in 4 cases, in 2 of which the stones were removed under endoscope during the procedure, and in 2 of which the stones were 〈 3 mm in diameter and no surgical intervention was employed. Postoperative follow-up found no common bile duct stones or cholangitis. Conclusions During EST combined with LC for treating cholelithiasis complicated with choledocholithiasis, the application of intraoperative cholangiography by way of ENBD is helpful to timely detection and treatment of secondary stones, which decreases the incidence of postoperative residual stones.
出处
《中国微创外科杂志》
CSCD
2006年第8期584-585,共2页
Chinese Journal of Minimally Invasive Surgery
