Clinical value and application of intraoperative cholangiography in laparoscopic biliary tract surgery
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摘要:
腹腔镜胆道手术最常见的手术并发症是胆道残余结石及胆管损伤。临床上常用的与胆石症相关的术前检查均具有一定的局限性。腹腔镜术中胆道造影的方法可以明确肝内外胆管结石的情况,预防术后胆道残余结石发生,预防和及时发现术中胆管损伤,提高胆管损伤修复的成功率。因此,掌握术中胆道造影的适应证并合理应用,具有重要的临床意义。本文从腹腔镜术中胆道造影的意义、腹腔镜术中胆道造影的适应证、方法及注意事项等几方面就胆道造影在腹腔镜胆道手术中的应用现况加以评述。
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关键词:
- 胰胆管造影术,内窥镜逆行 /
- 胆囊切除术,腹腔镜
Abstract:The most common complications of laparoscopic biliary tract surgery are residual stones and physical injury to the bile duct.However, the risk for both of these complications may be reduced significantly by the use of intraoperative cholangiography (IOC) during the laparoscopic biliary tract surgery.When properly applied with contrast medium, IOC can reveal the biliary tract anatomy and the stones within, thereby guiding the performance of the laparoscopic procedure to achieve complete removal of all stones while preventing biliary tract injury.Several features of the IOC procedure, such as the contrast agent, injection speed and volume, affect its clinical utility during the laparoscopic biliary tract surgery.Therefore, this review summarizes the significance, indications, and methods of IOC that facilitate its useful application in laparoscopic biliary tract surgery.
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Key words:
- cholangiopancreatography /
- endoscopic retrograde
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[1]黄志强.黄志强胆道外科[M].济南:山东科学技术出版社, 1998:70-100. [2]王智峰, 祝学光, 刘玉兰.胆石症的诊断与治疗进展[J].临床消化病杂志, 2006, 18 (6) :325-327. [3]裘法祖, 吴阶平.黄家驷外科学[M].第6版.北京:人民卫生出版社, 2000:1269. [4]Flum DR, Dellinger EP, Cheadle A, et al.Intraoperative cholangiog-raphy and risk of common bile duct injury during cholecystectomy[J].JAMA, 2003, 289 (13) :1639-1644. [5]Archer SB, Brown DW, Smith CD, et al.Bile duct injury duringlaparoscopic cholecystectomy:results of a national survey[J].AnnSurg, 2001, 234 (4) :549-559. [6] Ausania F, Holmes LR, Iype S, et al.Intraoperative cholangiographyin the laparoscopic cholecystectomy era:why are we still debating?[J].Surg Endosc, 2012, 26 (5) :1193-1200. [7]Cuschieri A, Shimi S, Banting S, et al.Intraoperative cholangiog-raphy during laparoscopic cholecystectomy.Routine vs selective pol-icy[J].Surg Endosc, 1994, 8 (4) :302-305. [8] Podnos YD, Gelfand DV, Dulkanchainun TS, et al.Is intraopera-tive cholangiography during laparoscopic cholecystectomy costeffec-tive?[J].Am J Surg, 2001, 182 (6) :663-669. [9]Buddingh KT, Morks AN, Ten Cate Hoedemaker HO, et al.Docu-men-ting correct assessment of biliary anatomy during laparoscopiccholecystectomy[J].Surg Endosc, 2012, 26 (1) :79-85. [10]Stewart L, Way LW.Bile duct injuries during laparoscopic Cholecystec-tomy.Factors that influence the results of treatment[J].Arch Surg, 1995, 130 (10) :1123-1128, discussion 1129. [11]Massarweh NN, Devlin A, Elrod JA, et al.Surgeon knowledge, behav-ior, and opinions regarding intraoperative cholangiography[J].J AmColl Surg, 2008, 207 (6) :821-830. [12]Ludwig K, Bernhardt J, Steffen H, et al.Contribution of intraopera-tive cholangiography to incidence and outcome of common bile ductinjuries during laparoscopic cholecystectomy[J].Surg Endosc, 2002, 16 (7) :1098-1104. [13]Z’Graggen K, Wehrli H, Metzger A, et al.Complications of lapa-roscopic cholecystectomy in Switzerland.A prospective 3-yearstudy of 10, 174 patients.Swiss Association of Laparoscopic andThoracoscopic Surgery[J].Surg Endosc, 1998, 12 (11) :1303-1310. [14]Soper NJ, Brunt LM.The case for routine operative cholangiographyduring laparoscopic cholecystectomy[J].Surg Clin North Am, 1994, 74 (4) :953-959. [15]Flowers JL, Zucker KA, Graham SM, et al.Laparoscopic cholangiogra-phy.Results and indications[J].Ann Surg, 1992, 215 (3) :209-216. [16]Flum DR, Flowers C, Veenstra DL.A cost-effectiveness analysisof intraoperative cholangiography in the prevention of bile duct injuryduring laparoscopic cholecystectomy[J].J Am Coll Surg, 2003, 196 (3) :385-393. [17]Phillips EH.Routine versus selective intraoperative cholangiography[J].Am J Surg, 1993, 165 (4) :505-507. [18]Roy PG, Soonawalla ZF, Grant HW.Medicolegal costs of bile ductinjuries incurred during laparoscopic cholecystectomy[J].HPB (Oxford) , 2009, 11 (2) :130-134. [19]Podnos YD, Gelfand DV, Dulkanchainun TS, et al.Is intraoperativecholangiography during laparoscopic cholecystectomy cost effective?[J].Am J Surg, 2001, 182 (6) :663-669. [20]Wu CX, Gong JP, Liu CA, et al.The significance of intraoperativecholangiography in laparoscopic cholecystectomy[J].J ChongqingMed Univ, 2005, 30 (5) :687-689. (in Chinese) 吴传新, 龚建平, 刘长安, 等.选择性应用术中胆道造影在腹腔镜胆囊切除术中的价值[J].重庆医科大学学报, 2005, 30 (5) :687-689. [21]Tang XY, Wang DH, Zhu XM.Analysis of 151 patients with intra-operative cholangiography application[J].Chin J Bases Clin Gener-al Surg, 2010, 17 (3) :287-288. (in Chinese) 唐晓勇, 王东红, 朱晓铭.术中胆道造影151例应用体会[J].中国普外基础与临床杂志, 2010, 17 (3) :287-288. [22]刘凤祝, 李铎, 刘擎.腹腔镜胆囊切除术中胆道造影的应用体会[J].当代医学, 2011, 17 (25) :84-85. [23]He HS, Qin T, Fu XL.The clinical value of intraoperative cholan-giography in laparoscopic cholecystectomy[J].Chin Modern Med, 2010, 17 (7) :39-40. (in Chinese) 向海山, 秦涛, 付小兰.腹腔镜胆囊切除术中胆道造影的临床应用[J].中国当代医药, 2010, 17 (7) :39-40.
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