胆总管探查在胆管结石中应用的临床分析(1)
摘 要：目的 探讨开腹胆总管探查的适应条件、必要性、并发症及胆总管探查的最新进展。方法 对两家医院在2014年1月～2017年6月行开腹胆囊切除胆总管探查术62例患者的临床资料进行回顾性分析，探讨术中胆总管探查的必要性。结果 62例均痊愈，术中证实胆总管扩张 54例，胆总管探查发现结石50例，术中胆道镜探查发现残余结石14例，术后有4例患者出现并发症，其中胆总管残余结石1例，胆道感染2例，胆汁性腹膜炎1例。结论 开腹进行胆总管探查仍具有不可替代的位置，对于胆管多发结石、胆总管明显扩张的患者，术中胆道镜探查是必要的。
关键词：胆总管扩张；胆管结石；胆总管；胆道镜
中图分类号：R364.2+5；R575.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.031
文章编号：1006-1959(2018)15-0099-04
, 百拇医药
Clinical Analysis of Exploration of the Common Bile Duct in Calculus of Bile Duct
LI Yan-xun1，SUN Jin-jin2
(1.Tianjin Baodi People's Hospital/Department of General Surgery，Baodi Clinical College of Tianjin Medical University，Tianjin 301800，China；
2.Second Hospital Affiliated to Tianjin Medical University/Tianjin Medical University，Tianjin 300070，China)
Abstract：Objective To explore the suitable conditions，necessity，complications and the latest progress of common bile duct exploration.Methods From January 2014 to June 2017，62 cases of choledochus exploration with open cholecystectomy and common bile duct exploration in two hospitals were retrospectively analyzed，and the necessity of common bile duct exploration during operation was discussed.Results All the 62 cases were cured， 54 cases were proved to have common bile duct dilatation，50 cases were found stones in common bile duct exploration，14 cases were found residual calculus during choledochoscopy during the operation.Postoperative complications occurred in 4 patients，including 1 case of residual calculus in common bile duct，2 cases of biliary tract infection，and 1 case of biliary peritonitis.Conclusion Open and exploration of the common bile duct still has an irreplaceable position.For patients with multiple bile duct calculus and obvious choledochectasia， intraoperative choledochoscopy is necessary.
, 百拇医药
Key words：Common bile duct dilatation；Calculus of bile duct；Common bile duct；Choledochoscope
膽囊结石(cholecystolithiasis)是最常见的胆系外科疾病，临床上有15%～18%的患者同时伴有胆总管结石。随着腹腔镜等微创手术的飞速发展，腹腔镜胆囊切除术正逐步取代开腹手术，并具有更高的安全性和有效性[1]。腹腔镜胆囊切除术在手术切口美观及术后恢复等方面优于开腹手术，但是腔镜手术操作相对复杂，手术视野暴露不良，在面对胆囊粘连严重、解剖结构变异的患者时，可能会延长手术操作时间并同时增加术后并发症的风险[2]。腹腔镜胆囊切除术成为众多患者的首选手术方案，但是在胆囊多发结石、胆总管扩张、不明原因的梗阻性黄疸、胆管解剖结构变异等情况下，腔镜手术尚不能完全取代开腹手术，开腹胆囊切除胆总管探查有自己的优势。因此，笔者探讨在胆道系统结石患者中，开腹胆总管探查的适应条件、必要性、并发症以及胆总管探查的最新治疗。
1资料与方法
1.1一般材料 选取天津市宝坻区人民医院和天津医科大学第二医院在2014年1月～2017年6月行开腹胆囊切除胆总管探查术的患者62例。其中男 28例，女 34例，年龄21～82岁，平均年龄(64.80±16.80)岁。术前均经B超或MRCP证实存在胆囊结石、胆管结石或胆总管扩张。胆总管直径(1.37±0.45)cm，其中8例<1 cm，54例>1 cm；B超提示胆囊壁增厚31例，其中最厚达0.6 cm；伴有梗阻性黄疸32例， 急性胰腺炎11例，合并有高血压26例，糖尿病34例；8例患者有腹部手术史，其中胃大部切除术2例，结肠癌根治术1例。, http://www.100md.com(李衍训 孙晋津)
关键词：胆总管扩张；胆管结石；胆总管；胆道镜
中图分类号：R364.2+5；R575.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.031
文章编号：1006-1959(2018)15-0099-04
, 百拇医药
Clinical Analysis of Exploration of the Common Bile Duct in Calculus of Bile Duct
LI Yan-xun1，SUN Jin-jin2
(1.Tianjin Baodi People's Hospital/Department of General Surgery，Baodi Clinical College of Tianjin Medical University，Tianjin 301800，China；
2.Second Hospital Affiliated to Tianjin Medical University/Tianjin Medical University，Tianjin 300070，China)
Abstract：Objective To explore the suitable conditions，necessity，complications and the latest progress of common bile duct exploration.Methods From January 2014 to June 2017，62 cases of choledochus exploration with open cholecystectomy and common bile duct exploration in two hospitals were retrospectively analyzed，and the necessity of common bile duct exploration during operation was discussed.Results All the 62 cases were cured， 54 cases were proved to have common bile duct dilatation，50 cases were found stones in common bile duct exploration，14 cases were found residual calculus during choledochoscopy during the operation.Postoperative complications occurred in 4 patients，including 1 case of residual calculus in common bile duct，2 cases of biliary tract infection，and 1 case of biliary peritonitis.Conclusion Open and exploration of the common bile duct still has an irreplaceable position.For patients with multiple bile duct calculus and obvious choledochectasia， intraoperative choledochoscopy is necessary.
, 百拇医药
Key words：Common bile duct dilatation；Calculus of bile duct；Common bile duct；Choledochoscope
膽囊结石(cholecystolithiasis)是最常见的胆系外科疾病，临床上有15%～18%的患者同时伴有胆总管结石。随着腹腔镜等微创手术的飞速发展，腹腔镜胆囊切除术正逐步取代开腹手术，并具有更高的安全性和有效性[1]。腹腔镜胆囊切除术在手术切口美观及术后恢复等方面优于开腹手术，但是腔镜手术操作相对复杂，手术视野暴露不良，在面对胆囊粘连严重、解剖结构变异的患者时，可能会延长手术操作时间并同时增加术后并发症的风险[2]。腹腔镜胆囊切除术成为众多患者的首选手术方案，但是在胆囊多发结石、胆总管扩张、不明原因的梗阻性黄疸、胆管解剖结构变异等情况下，腔镜手术尚不能完全取代开腹手术，开腹胆囊切除胆总管探查有自己的优势。因此，笔者探讨在胆道系统结石患者中，开腹胆总管探查的适应条件、必要性、并发症以及胆总管探查的最新治疗。
1资料与方法
1.1一般材料 选取天津市宝坻区人民医院和天津医科大学第二医院在2014年1月～2017年6月行开腹胆囊切除胆总管探查术的患者62例。其中男 28例，女 34例，年龄21～82岁，平均年龄(64.80±16.80)岁。术前均经B超或MRCP证实存在胆囊结石、胆管结石或胆总管扩张。胆总管直径(1.37±0.45)cm，其中8例<1 cm，54例>1 cm；B超提示胆囊壁增厚31例，其中最厚达0.6 cm；伴有梗阻性黄疸32例， 急性胰腺炎11例，合并有高血压26例，糖尿病34例；8例患者有腹部手术史，其中胃大部切除术2例，结肠癌根治术1例。, http://www.100md.com(李衍训 孙晋津)