Qandeel Haitham, Zino Samer, Hanif Zulfiqar, Nassar M Kazem, Nassar Ahmad H M
Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK.
Surg Endosc. 2016 May;30(5):1958-64. doi: 10.1007/s00464-015-4421-5. Epub 2015 Jul 22.
BACKGROUND: When common bile duct (CBD) stones are detected during laparoscopic cholecystectomy, the insertion of baskets via the cystic duct (CD) can be difficult and may occasionally cause complications. We introduced a new technique 'basket in catheter' (BIC) for transcystic CBD exploration. METHODS: Although cannulating the CD using a cholangiography catheter is successful in most cases, it may occasionally be difficult. Cystic duct anatomy may prevent the usually stiffer sharper tip of the basket, from entering the CBD, resulting in failure, perforation or a false passage. In the majority of our cases, the cholangiography catheter (CC) is not withdrawn from the duct should the intraoperative cholangiography show CBD stones. The tip of a basket is inserted into the CC and advanced to a predetermined distance, allowing the tip of the basket to exit the end of the CC into the CBD. The basket is then opened, advanced to feel the lower end and manipulated to trap the stone. The common hepatic duct is compressed gently to prevent stones from slipping upwards. The catheter and basket are pulled back together to extract the stone. RESULTS: We have used this technique in 274 cases since 2010. The rate of transcystic versus choledochotomy stone extraction has increased, saving unnecessary choledochotomies. The percentage of transcystic exploration increased from 55 % for the period 2005-2009 to 70 % for the period 2010-2014. There were no conversions to open surgery and no retained stones. The morbidity rate was 4.0 % with no mortality. CONCLUSIONS: We demonstrate a technique to facilitate the insertion of extraction baskets into the common bile duct using the cholangiography catheter as a guide. The 'basket-in-catheter' (BIC) technique for transcystic CBD exploration is easier and safer than inserting the basket alone.
背景:在腹腔镜胆囊切除术期间检测到胆总管(CBD)结石时,经胆囊管(CD)插入取石篮可能困难,且偶尔会引起并发症。我们引入了一种新的技术“导管内取石篮”(BIC)用于经胆囊管胆总管探查。 方法:尽管使用胆管造影导管插入胆囊管在大多数情况下是成功的,但偶尔也可能困难。胆囊管解剖结构可能会阻止通常更硬更尖的取石篮尖端进入胆总管,导致操作失败、穿孔或形成假道。在我们的大多数病例中,如果术中胆管造影显示胆总管结石,胆管造影导管(CC)不撤出胆管。将取石篮尖端插入CC并推进到预定距离,使取石篮尖端从CC末端穿出进入胆总管。然后打开取石篮,推进以触及下端并操作以套住结石。轻轻压迫肝总管以防止结石向上滑动。将导管和取石篮一起拉回以取出结石。 结果:自2010年以来,我们已在274例病例中使用了该技术。经胆囊管与胆总管切开取石的比例有所增加,避免了不必要的胆总管切开术。经胆囊管探查的比例从2005 - 2009年期间的55%增加到2010 - 2014年期间的70%。没有转为开放手术的情况,也没有残留结石。发病率为4.0%,无死亡病例。 结论:我们展示了一种以胆管造影导管为引导,便于将取石篮插入胆总管的技术。用于经胆囊管胆总管探查的“导管内取石篮”(BIC)技术比单独插入取石篮更容易、更安全。
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