Millat B, Borie F, Fingerhut A
Department of Visceral Surgery "A", University Hospital Saint Eloi, Montpellier, France.
Semin Laparosc Surg. 2000 Dec;7(4):279-87.
Laparoscopic exploration of the common bile duct (CBD) is performed either for the diagnosis or the treatment of CBD stones. Laparoscopic intraoperative cholangiography (IOC) versus ultrasonography (LUS) and laparoscopic versus endoscopic extraction of CBD stones were compared through a review of the prospective, comparative studies, randomized or not, evaluating these different techniques. Cystic duct cholangiography and fluoroscopic imaging are the standards for IOC. The potential protective effect of IOC regarding the risk or severity of CBD injuries might be the major argument for a routine use of laparoscopic IOC. Most if not all the purported advantages of LUS versus IOC for the diagnosis of CBD stones remain to be proven. Laparoscopic intraoperative diagnosis of CBD stones by cholangiography or ultrasonography followed by the laparoscopic extraction or, in case of failure, by postoperative endoscopic sphincterotomy, might represent the future for the diagnosis and treatment of CBD stones.
腹腔镜胆总管（CBD）探查术用于诊断或治疗CBD结石。通过回顾前瞻性、对比性研究（无论是否随机）来比较腹腔镜术中胆管造影（IOC）与超声检查（LUS）以及腹腔镜与内镜下CBD结石取出术，这些研究评估了这些不同技术。胆囊管胆管造影和荧光透视成像为IOC的标准。IOC对CBD损伤风险或严重程度的潜在保护作用可能是常规使用腹腔镜IOC的主要依据。LUS相对于IOC在诊断CBD结石方面所谓的大多数（如果不是全部）优势仍有待证实。通过胆管造影或超声检查在腹腔镜术中诊断CBD结石，随后进行腹腔镜取出，或在失败的情况下进行术后内镜括约肌切开术，可能代表着CBD结石诊断和治疗的未来方向。
