摘要
探讨腹腔镜超声技术在ＬＣ中的临床应用价值和开创腔镜诊治胆石症的新途径。方法：３２０例ＬＣ病人常规行腹腔镜超声检查（ＬＵＳ）；５０例行腹腔镜超声和术中胆管造影（ＩＯＣ）对比研究。胆管结石采用ＥＲＣＰ／ＥＳＴ和腹腔镜胆囊切除胆总管切开探查取石Ｔ管引流或一期缝合术治疗。结果：ＬＵＳ平均检查时间１５ｍｉｎ，对胆道系统和血管９８％显像。胆总管末端８６％显像，３％发现未预期胆管结石，发现１０％胆囊管解剖变异；ＬＵＳ和ＩＯＣ对比结果显示：ＬＵＳ胆总管结石检出敏感性、特异性和总诊断正确率均优于ＩＯＣ（分别为８３％，９８％，９８％和７６％，９５％，９５％），两者结合则高达１００％。ＥＲＣＰ／ＥＳＴ成功率达９０％，３０例腹腔镜胆总管探查取石术平均手术时间３．５ｈ，２５例置Ｔ管引流、５例一期胆管缝合，均获成功，未发生胆漏胆管损伤等并发症，术后残石者经Ｔ管胆道镜取石治愈。结论：ＬＣ中常规使用腹腔镜超声技术有助于判断胆道生理和病理解剖结构、防止发生胆管损伤；有助于发现确诊或排除肝内外胆管结石、为胆管造影和胆道探查术提供重要指征，降低胆道残石和阴性胆道探查率。腹腔镜超声指导下的腹腔镜胆囊切除胆道探查取石Ｔ管引流或一期胆管缝合术安全可靠?
Objective:To Study the value of laparoscopic ultrasonography(LUS)in laparoscopic cholecystectomy and common bile duct exploration (LCBDE),and explore a new minimally invasive technique for the diagnosis and management of choledocholithiasis.Methods:LUS had been routinely applied in 320 laparoscopic cholecystectomies within 2 years,with a comparison of LUS and intraoperative cholangiography(IOC) in 50 cases;ERCP/EST and LCBDE with T-tube drainage of primary duct closure were performed on patients with choledocholithiasis.Results:The mean time taken for the examination of LUS was 15min.Accurate identification of the biliary anatomy and vascular structures was made possible by LUS including visualizations of gallbladder and portal vein(100%),hepatic and common bile ducts(98%),and the end of CBD(86%).3% unsuspected CBD stones and 10% anatomical anomolies of cystic duct were also detected by LUS.LUS was shown to be superior to IOC for the detection of stones:the sensitivities,specificities,and accuracies were 83%,98% and 98% by LUS,and 76%,95% and 95% by IOC,respectively.The successful rate of ERCP/EST was 90%,and the LCCBDE was successfully performed on 30 patients with T-tube insertion in 25 cases and primary duct closure in 5 cases,and with no occurrence of biliary leakage and injury.The retained stones were cleared out by flexible choledochoscope via the T-tube tunnel.Conclusion:LUS routinely performed during LC can be useful in preventing the bile duct injury by delineating biliary anatomy and anomaly,and reducing the rates of retained stones and negative CBDE by detecting or excluding suspectable bile duct stones.LCCBDE either with T-tube drainage or primary duct closure under the guidance of LUS is a asfe,efficient,and reliable new minimally invasive technique for the management of bile duct calculi.
出处
《中国内镜杂志》
CSCD
1999年第3期4-6,8,共4页
China Journal of Endoscopy
关键词
腹腔镜
胆囊切除
胆道探查
超声波诊断
Laparoscopic ultrasonography
laparoscopic cholecystectomy
common bile duct exploration$$$$
