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经胆囊管探查胆总管应用价值的探讨 |
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乔建国 陈纪伟 贺银成
［摘要］ 目的 探讨经 胆囊管探查胆总管的适应证、方法和应用价值。方法 距胆总管0.5 ～1 cm切断胆囊管，除去胆囊，血管钳提起管腔边缘，插入弯成弧形的探条探查胆总管。如 探条受阻，以探条为引导，触摸探条尖端附近，有助于鉴别结石、肿瘤或炎性狭窄。结果 51例胆囊结石，探查36例，阳性7例(19.4%)，其中有探查指征6例 ，阳性4例(66.6%)；无探查指征30例，阳性3例(10%)。结论 经胆 囊管探查胆总管无创、便捷，能准确发现胆总管病变，凡胆囊管径＞0.3 cm者，应采用该 法探查。
［关键词］ 胆囊管； 探查； 胆总管； 结石
［中图分类号］ R657.4 ［文献标识码］ A ［文章编号］ 1005- 6483(2000)06-0340-02
Evaluation on the exploration of choledochus through cystic duct
QIAO Jianguo,CHEN Jiwei,HE Yinchen
（Department of General Surgery,Se cond Affiliated Hospital,Hubei Medical University,Wuhan 430071，China）
［Abstract］ Objective To study the indication,method and value of choledochal exploration through cystic duct.Methods The cystic duct was cut 0.5～1 cm from choledochus and its edge was raise d with a forceps and a bakes dilator was inserted to probe the bill duct.If the dilator can not pass the choledochus,palpation around the point of dilator would help to distinguish the stone tumor or narrow.Results In 51 pati ents with cholecystitis and cholelithiasis,36 were explorated,of which 6 had the explorative indications,4 were postive(66.6%);in 30 without the indications,3 we re positive(10%).The total positvity was 19.4%.Conclusions This method is less-traumatic,convenient and able to find choledochal disease a ccurately.The exploration would be done if the cystic duct is over 0.3 cm in dia meter.
［Key words］ Cystic duct; Exploration; Choledochal； Stone
我们自1993年开始，对可疑梗阻胆总管先采用经胆囊管探查，以避 免切开无辜胆总管。对无胆总管探查指征，但胆囊管口径能通过探条的病例也用该法探查， 以避免遗漏病变，报告如下。
临床资料
一、一般资料：胆囊结石并胆囊炎行胆囊切除51例，其中男12例，女39例。年龄31～69岁 ，平均48岁。术前B超均未发现胆总管结石，探查36例，探查率70.5%。根据胆总管探查 指征［ 1］分组，结果见表1。5例结石2例推入肠腔，3例切开胆总管取石。2例狭窄行Oddi括约 肌切开成形。15例未能探查，其中11例为狭细胆囊管，4例胆囊管走向异常。全部病人术后 随访3～12个月，B超复查胆总管正常，无胆道梗阻症状。
表1 36例经胆囊管探查胆总管结果
分 组 例数 结石 狭窄 阳性率(%)
有探查指征 6 3 1 66.6
无探查指征 30 2 1 10
合 计 36 5 2 19.6
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