张建　李晓辉　卢智略　蔡晓瑜

【摘要】 目的 分析自制造影针腹腔镜胆囊切除术（LC）中胆道造影与传统LC术中胆道造影的优势、劣势。方法 85例行LC术需行术中胆道造影的患者随机分为三组：A组（34例）为自制造影针造影组；B组（22例）为Olsen胆道造影固定钳组；C组（29例）为软质导管造影组。比较自制造影针LC术中胆道造影和传统术中胆道造影所需时间、并发症、造影成功率等。结果 B、C组造影所需时间分别为（15.50±3.95）、（14.00±3.37）min；A组造影所需时间（3.00±1.12）min， A组所需时间显著少于B、C组， 差异有统计学意义（P<0.01）。A组无并发症发生且成功率为100.00%；B组1例中转开腹， 1例发生胆漏， 造影成功率100.00%；C组无并发症发生， 造影成功率97.65%。结论 自制造影针LC术中胆道造影是创新的胆道造影方法， 操作简单且效果好， 对于设备要求低， 可缩短手术时间， 可在各医院普及、应用。

【关键词】 术中胆道造影；腹腔镜胆囊切除术；自制造影针

DOI：10.14163/j.cnki.11-5547/r.2016.05.004

Comparison between intraoperative cholangiography by self-made imaging needle in LC and traditional intraoperative cholangiography method ZHANG Jian， LI Xiao-hui， LU Zhi-lue， et al. Department of General Surgery， Puning City Peoples Hospital， Puning 515300， China

【Abstract】 Objective To analyze advantages and disadvantages of intraoperative cholangiography by self-made imaging needle in laparoscopic cholecystectomy （LC） and traditional intraoperative cholangiography method. Methods A total of 85 patients needing intraoperative cholangiography in LC were randomly divided into three groups. Group A （34 cases） was self-made imaging needle cholangiography group， group B （22 cases） was Olsen cholangiography fixed clamp group， and group C （29 cases） was soft tube cholangiography group. Comparisons were made on operation times， complications， and success rate of radiography between intraoperative cholangiography by self-made imaging needle in LC and traditional intraoperative cholangiography. Results Operation time of cholangiography were （15.50±3.95） and （14.00±3.37） min in groups B and C， and that in group A was （3.00±1.12） min. Group A had obviously shorter time than groups B and C， and the difference had statistical significance （P<0.01）. There was no complicated occurred in group A， with the success rate as 100.00%. There were 1 case receiving alternative laparotomy and 1 case with bile leakage in group B， and its success rate as 100.00%. Group C had no occurred complicated， with success rate as 97.65%. Conclusion Implement of intraoperative cholangiography by self-made imaging needle in LC is an innovative method with easy operation and precise effect. This method contains low equipment requirements. It can shorten operation time and be promoted and applied in hospital.

【Key words】 Intraoperative cholangiography； Laparoscopic cholecystectomy； Self-made imaging needle

术中胆道造影（IOC）当前主要运用于胆道手术， 技术也比较成熟， 同时， 手术中胆道造影可以准确了解胆管内是否存在结石病变的情况， 也可明确结石的位置、数量、大小， 同时还能发现在手术前一些漏诊的患者。对于胆总管切开取石具有指导性， 还能避免不必要的胆总管切开的探查， 并把创伤减至最小。IOC亦可用来诊断胰胆管合流的异常、手术诊断胆胰管损伤等， 全方位对其结构进行了解， 指导手术方向。可以减少胆道残石发生率；及时发现胆道损伤；减少中转开腹和阴性探查的需要[1， 2]。

有相关报道表明（国外）：具有胆总管探查指征患者行胆总管探查其“-”性高达50%～70%[3]， 胆道探查前常规行术中胆道造影， 可明显减少不必要的胆道损伤和阴性探查机会。

1 资料与方法

1. 1 一般资料 选择2013年4月～2015年4月在本院行LC术需行术中胆道造影患者85例， 其中女、男分别为46、39例， 平均年龄40.9岁， 病史3～25 d。……