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腹腔镜胆囊切除术前行静脉胆管造影的价值。

Value of intravenous cholangiography prior to laparoscopic cholecystectomy.

作者信息

Jansen M, Truong S, Treutner K H, Neuerburg J, Schraven C, Schumpelick V

机构信息

Department of Surgery, Rhenish Westfalian Technical University, Pauwelsstrasse 30, D-52057 Aachen, Germany.

出版信息

World J Surg. 1999 Jul;23(7):693-6; discussion 697. doi: 10.1007/pl00012370.

Abstract

We performed a retrospective study on 163 patients for evaluation of the benefit of intravenous cholangiography prior to laparoscopic cholecystectomy. Radiographic evaluation of the various areas of the biliary system was classified regarding resolution of anatomic structures: well detailed (excellent), impaired image but reliable interpretation possible (good), insufficient contrast with limited assessment (poor), no reliable judgment possible (insufficient). The common bile duct could be described as "good" in 96.3%, whereas the cystic duct could be described as "good" in only 54.6%. Concrements of the gallbladder were recognized in 72.4%, and common bile duct stones were diagnosed in only two of three patients. A distal junction of the cystic duct was found in nine cases, but there was no influence on the following operative procedure. Only one of two patients with a short cystic duct was identified. We found no improvement after routine use of intravenous cholangiography concerning the evidence of common bile duct stones or the avoidance of lesions of the common bile duct. Hence routine use of intravenous cholangiography prior to laparoscopic cholecystectomy is not justified.

摘要

我们对163例患者进行了一项回顾性研究,以评估腹腔镜胆囊切除术前行静脉胆管造影的益处。根据解剖结构的显示情况,对胆道系统各区域的影像学评估分为:显示清晰(优秀)、图像受损但仍可进行可靠解读(良好)、对比度不足且评估受限(差)、无法进行可靠判断(不足)。胆总管显示为“良好”的比例为96.3%,而胆囊管显示为“良好”的比例仅为54.6%。72.4%的患者发现胆囊有结石,3例患者中仅2例诊断出胆总管结石。9例发现胆囊管远端汇合,但对后续手术操作无影响。仅识别出2例胆囊管短的患者中的1例。我们发现,常规使用静脉胆管造影在胆总管结石的检出或避免胆总管损伤方面并无改善。因此,腹腔镜胆囊切除术前行常规静脉胆管造影并无必要。

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