Fitzgibbons R J, Ryberg A A, Ulualp K M, Nguyen N X, Litke B S, Camps J, McGinn T R, Jenkins J X, Filipi C J
Department of Surgery, Creighton University School of Medicine, Omaha, Neb., USA.
Arch Surg. 1995 Jun;130(6):638-42. doi: 10.1001/archsurg.1995.01430060076014.
To introduce a new strategy for dealing with abnormal cholangiograms at laparoscopic cholecystectomy that makes postoperative cholangiograms possible and facilitates stone extraction by assuring access to the duct for a guide-wire-assisted endoscopic retrograde sphincterotomy.
Retrospective review of a prospectively maintained database.
Twenty-four patients with abnormal cholangiograms had a percutaneously placed double-lumen catheter threaded through the cystic duct and advanced into the duodenum.
Ten successful guide-wire-assisted endoscopic retrograde sphincterotomies were performed without complications. Eleven normal postoperative cholangiograms suggested spontaneous stone passage or false-positive intraoperative cholangiograms. There were three technical failures in the early part of the series.
This strategy is a reasonable alternative to laparoscopic common bile duct exploration (1) when the cholangiogram is questionably positive, (2) when prolonged anesthesia (poor-risk patient) should be avoided, (3) when the equipment for laparoscopic common bile duct exploration is not available, and (4) when spontaneous stone passage seems likely. Postoperative endoscopic retrograde sphincterotomy with stone extraction is facilitated when it becomes necessary because a guide wire can be introduced through the catheter.
介绍一种在腹腔镜胆囊切除术中处理异常胆管造影的新策略，该策略可使术后胆管造影成为可能，并通过确保导丝辅助内镜逆行括约肌切开术能够进入胆管来促进结石取出。
对前瞻性维护的数据库进行回顾性分析。
24例胆管造影异常的患者经皮放置双腔导管，穿过胆囊管并推进至十二指肠。
成功进行了10例导丝辅助内镜逆行括约肌切开术，无并发症发生。11例术后胆管造影正常提示结石自行排出或术中胆管造影假阳性。该系列早期有3例技术失败。
当胆管造影结果可疑为阳性时、当应避免长时间麻醉（高危患者）时、当没有腹腔镜胆总管探查设备时以及当结石似乎可能自行排出时，该策略是腹腔镜胆总管探查的合理替代方法。当有必要时，由于可通过导管引入导丝，便于术后进行内镜逆行括约肌切开术并取出结石。
