Motson R W, Shinkwin M A, May A R, Akhtar N
Colchester General Hospital, Essex.
Ann R Coll Surg Engl. 1988 May;70(3):135-8.
Operative cholangiography is for most surgeons a routine part of every cholecystectomy. Computerised digital subtraction angiography was adapted for operative cholangiography using a portable machine. After cannulation of the cystic duct the background image was subtracted before injecting contrast. Only the contrast within the bile duct appears on the monitor and resolution is high. A permanent record was made on 10 X 10 cm spot films. Eighteen pre-exploratory cholangiograms were performed using this method. In 12 no stones were demonstrated on digital subtraction cholangiography (DSC), nor were there clinical indications of common bile duct stones. These patients underwent cholecystectomy only. Stones were demonstrated on DSC in 3 patients and all had stones at exploration of the common bile duct (CBD). Three patients had no stones demonstrated on DSC but were explored on clinical grounds. No stones were found. Postoperative T-tube cholangiograms confirmed the absence of stones in 5 patients. A retained stone was present in one patient who had not had a postexploratory examination at operation and was not related to the use of this cholangiographic technique. DSC combines the benefits of image intensification and still radiography and has been accurate in both predicting and excluding common bile duct stones.
对于大多数外科医生来说，术中胆管造影是每例胆囊切除术的常规组成部分。利用一台便携式设备，将计算机数字减影血管造影技术应用于术中胆管造影。在插入胆囊管后，在注入造影剂之前减去背景图像。监视器上仅显示胆管内的造影剂，且分辨率很高。在10×10cm的点片上进行永久记录。使用这种方法进行了18次术前胆管造影。12例患者在数字减影胆管造影（DSC）中未显示结石，也没有胆总管结石的临床指征。这些患者仅接受了胆囊切除术。3例患者在DSC中显示有结石，且在探查胆总管（CBD）时均发现有结石。3例患者在DSC中未显示结石，但基于临床原因进行了探查，未发现结石。术后T管胆管造影证实5例患者无结石。1例患者存在残留结石，该患者在手术时未进行探查后检查，且与这种胆管造影技术的使用无关。DSC结合了影像增强和静态放射摄影的优点，在预测和排除胆总管结石方面都很准确。
