腹腔镜胆总管探查术的理由。
The case for laparoscopic common bile duct exploration.
作者信息
Fielding George A
机构信息
The Wesley and Royal Brisbane Hospitals, Suite 93, SJB, Chasely St. Auchenflower, Queensland, Australia.
出版信息
J Hepatobiliary Pancreat Surg. 2002;9(6):723-8. doi: 10.1007/s005340200099.
The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.
现代外科医生处理胆总管结石的方法取决于其对胆管造影的看法。在20世纪90年代早期,出现了摒弃胆管造影的转变,而胆管造影此前是常见的做法。这是因为人们认为该技术操作困难、耗时,并且可能由于时间因素暗示成本增加。但没有证据支持这一决定。这导致内镜逆行胰胆管造影(ERCP)的使用显著增加。在腹腔镜胆囊切除术之前,有大量ERCP结果正常的病例。本文阐述了在胆囊切除时进行术中胆管造影和胆总管清理的理由。希望能采用这项技术,以便患者如果存在胆结石和胆总管结石,可以通过单一手术将其去除,减少术前ERCP结果正常的发生率,以及术后若发现结石进行二次手术清理结石的必要性。