Objective To evaluate the role of endoscopic retrograde cholangio-pancreatography(ERCP)in diagnosis of anomalous converge of the cystic duct and prevention of bile duct injuries during laparoscopic cholecystectomy(LC). Methods From July, 1992 to June, 1999, LCs were performed in 4 500 patients with gallbladder stone or cholecystitis at our center. Preoperative ERCPs were performed in 780 of all patients (14.50%). Anomalous junctions of the cystic duct with common hepatic duct were investigated and the length and caliber of these cystic duct were measured and compared with 100 control cases. Results An overall anomalous converges of the cystic duct were found in 125(16.03%) of the 780 patients undergoing ERCP. Of 780 patients undergoing LC, 35 cases were converted to open cholecystectomy(4.5%), and various complications occurred in 6 cases (0.77%), but no death and biliary duct injuries occurred. Conclusion Various types of anomalous junctions of the cystic duct could be diagnosed precisely by ERCP before LC and the preoperative examination of ERCP may be helpful in prevention of bile duct injuries and other biliary complications in the laparoscopic time.
目的 比较磁共振胰胆管成像（MRCP）三维质子加权快速自旋回波（SPACE）序列和半傅立叶采集单次激发快速自旋回波（HASTE）序列对胆囊管的显示情况，优选最佳的磁共振检查序列。 方法 2012年5月-2013年3月265例连续性患者同时采用SPACE序列和HASTE序列行MRCP检查，比较两种序列对胆囊管显示的图像质量和显示率，并进行统计学分析。 结果 SPACE序列对胆囊管显示的图像质量评分及显示率均优于HASTE序列 （P＜0.05）。 结论 SPACE序列是目前显示胆囊管较为理想的MRCP成像方法。
目的 总结开展腹腔镜下经胆囊管胆总管探查取石的手术技巧及应用体会。方法 回顾性分析笔者所在医院肝胆外科2010年7月至2012年12月期间行腹腔镜经胆囊管胆总管探查取石术的36例患者的临床资料。结果 30例病例经胆道探条扩张胆囊管后直接完成网篮取石，3例经胆囊管汇入胆总管处微切开完成取石，3例经胆道镜联合激光碎石完成手术。全组病例的手术时间为（110.88±25.99） min，术后住院时间为（6.59±1.18） d，均无严重操作相关并发症发生。结论 腹腔镜下经胆囊管胆总管探查取石术是安全可行的，若能综合各种技术，可提高手术的成功率。
ObjectiveTo evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.
【摘要】目的 探讨经胆囊管行术中胆道镜胆道探查的临床应用价值。 方法 对1997年9月至2004年12月期间60例开腹胆囊切除术患者经胆囊管行术中胆道镜胆道探查术，8例腹腔镜下经胆囊管行胆道镜胆道探查术的资料进行回顾性分析。结果 所有患者结石清除率为100%，术后平均住院7.2 d。结论 在无禁忌证的前提下，无论是开腹还是腹腔镜手术，应首先考虑经胆囊管途径行胆道镜胆道探查取石术。
目的 探讨腹腔镜下胆囊管结石的处理方法及并发症的预防。方法在2002年5月至2005年5月期间施行腹腔镜胆囊切除术（LC） 6 220例，其中胆囊管结石265例，对此进行回顾性分析。结果顺利完成LC 256例，中转开腹9例，无胆管损伤、出血、胆囊管残余结石病例的发生，2例出现胆瘘，经引流后治愈。结论严格规范的操作,良好显露胆囊三角,辨清肝总管、胆总管和胆囊管之间的关系,是正确处理胆囊管结石的关键。
Objective To explore the value for localization of cystic lymph node in laparoscopic cholecystectomy. Methods Clinical data of 100 cases who underwent laparoscopic cholecystectomy in Affiliated Hospital of Southern Medical University and The Third Division Hospital of Xinjiang Production and Construction Corps were collected to analyze retrospectively, for exploring the relationship of localization of cystic lymph node, cystic artery, cystic duct, and liver door. Results Of the 100 cases, 81 cases (81.0%) were found lymph node, in which 76 cases (76.0%) were found 1 lymph node and 5 cases(5.0%) were found lymph node more than 1, the other 19 cases(19.0%) were not found lymph node. Of the 76 cases who were found only 1 lymph node, lymph nodes were located above the anterior branch of cystic artery in 48 cases, below the anterior branch of cystic artery in 21 cases, and adjacent to the posterior branch of cystic artery in 7 cases. The operation was successful in all patients without death, of which 3 cases were transferred to laparotomy. The operation time were (43.0±6.5) min (25-116 min), and hospital stay after operation were (3.0±0.6) days (2-6 days). No serious complications of bile leakage, bile duct injury, and death happened after operation, and all cases were cured and discharged. Conclusion Cystic lymph node in the calot triangle is in relatively fixed position of laparoscopic cholecystectomy, it can help to guide judging anatomical hepatic portal region of each organization structure, and can to confirm the location of cystic artery and cystic duct, which is helpful to prevent injury during the operation of laparoscopic cholecystectomy.
Objectives To investigate the diagnosis and laparoscopic surgical treatment methods of calculus of cystic duct. MethodsThe clinical data of 147 patients with calculus of cystic duct underwent laparoscopic cholecystectomy (LC) in the Second Affiliated Hospital of Wenzhou Medical College from June 2008 to June 2013 were analyzed retrospectively. ResultsAmong the 147 patients with calculus of cystic duct, 19 cases were given preoperative diagnosis by B-ultrasound and CT scanning, 128 cases were found by exploration in operation; 146 cases underwent LC successfully and 1 case was converted to laparotomy.The 147 cases were followed-up for 3 months to 2 years with an average of 7 months and all cases were out of bile duct injury, hemorrhage, bile leakage, residual calculi or other complications. ConclusionsPreoperative diagnosis of calculus of cystic duct is difficult, meanwhile, routine intraoperative probe is very necessary for the diagnosis of calculus of cystic duct.Proficiency in surgical technique with laparoscopic treatment of calculus of cystic duct is the key to the success of LC.