CAJ | 학술논문

目的探讨胆管微切开取石术治疗胆管结石的优越性,进一步明确胆管取石后放置T管的适应范围.方法针对85例实施胆管微切开手术的患者,运用磁共振胰胆管造影(MRCP)、Advantage Workstation AW4.2～0.7sdc软件、术中胆管镜成像系统、图画等方法,对胆管微切开取石的适用范围进行了系统性讨论.结果研究提示,绝大多数胆管结石患者的胆总管宽度在8 mm以上,而胆管的宽度可能与结石的大小和多少相关.胆管宽度≥11 mm(n＝16)的MRCP结石影像面积较胆管宽度＜ 11 mm(n＝14)的MRCP结石影像面积显著性增大[(148±67) mm2比(47±31) mm2,P＜0.05].对于胆总管下段非游离、多发、结构致密结石,由于一次性彻底取石困难,需留置T管引流以备二次胆管镜检查.结论胆管微切开取石技术可避免大多数不必要的术后T管处理,尤其适合于早期诊断的胆管结石.T管引流多仅限于一次性彻底取石困难、病情复杂的患者.
목적 탐토담관미절개취석술치료담관결석적우월성,진일보명학담관취석후방치T관적괄응범위.방법 침대85례실시담관미절개수술적환자,운용자공진이담관조영(MRCP)、Advantage Workstation AW4.2～0.7sdc연건、술중담관경성상계통、도화등방법,대담관미절개취석적괄용범위진행료계통성토론.결과 연구제시,절대다수담관결석환자적담총관관도재8 mm이상,이담관적관도가능여결석적대소화다소상관.담관관도≥11 mm(n＝16)적MRCP결석영상면적교담관관도＜ 11 mm(n＝14)적MRCP결석영상면적현저성증대[(148±67) mm2비(47±31) mm2,P＜0.05].대우담총관하단비유리、다발、결구치밀결석,유우일차성철저취석곤난,수류치T관인류이비이차담관경검사.결론 담관미절개취석기술가피면대다수불필요적술후T관처리,우기괄합우조기진단적담관결석.T관인류다부한우일차성철저취석곤난、병정복잡적환자.
Objective To explore the advantages of the technique of bile duct mini-incision (BDM) for stone removal in choledocholithiasis,and to further clarify the indications for T tube insertion during surgery.Methods 85 BDM operations were performed.The use of MRCP (Magnetic resonance cholangiopancreatography),Advantage Workstation AW4.2 0.7sdc software,choledochoscopic imaging system and illustrations were used to study the applicability of the BDM technique in stone removal.Results The width of common bile duct (CBD) was usually over 8 mm in the patients with choledocholithiasis,and the width was related to the number and size of the stones.In the patients who had a CBD width of over 11mm (n 16),the MRCP stone imaging area (MRCP-SIA) was significantly larger when compared with that [(148±67)mm2 vs.(47±31)mm2,P＜0.05] in the patients (n=14) with CBD width of less than 11 mm.T tube insertion for secondary choledochoscopic examination should be performed when the stones were non drifting,multiple,and closely related to the lower part of CBD indicating difficulty in complete stone removal.Conclusions Unnecessary T tube insertion could be avoided by the BDM technique for stone removal which was especially suitable for patients with early diagnosis of choledocholithiasis.T tube insertion should only be performed in patients with difficulty in complete stone removal and in other complicated situations.