摘要目的 探讨腹腔镜胆管探查术中应用经胆囊管取石网篮行胆管造影、取石及再造影技术的价值.方法 收集2008年1月至2011年2月在我院行腹腔镜胆管探查术的患者资料,共185例.所有患者术中均采用经胆囊管取石网篮插管造影处理.造影阳性者利用网篮直接取石,或以胆管镜辅助取石治疗.取石后再次行胆管造影了解胆管通畅情况.结果 185例患者术中胆管造影均成功.60例胆管造影阳性,其中45例经胆囊管利用网篮直接成功取石,10例通过胆囊管胆总管微切口、胆管镜辅助成功取石,5例中转开腹行胆管探查处理.取石后均再次行胆管造影未见结石残留.结论 腹腔镜胆管探查术中,经胆囊管利用取石网篮行胆管造影、取石及再造影可及时发现胆总管结石,有效避免不必要胆管阴性探查.胆管取石操作简单、可靠,取石术后胆管清晰、通畅,值得临床推广.

abstractsObjective To explore the efficacy of the technique of reticular basket through cystic duct stone removal during laparoscopic common bile duct exploration.Methods From January 2008 to February 2011,185 patients received laparoscopic bile duct exploration in our hospital.These patients underwent intraoperative cholangiography (IOC) through the cystic duct with a reticular basket.With the help of a choledochoscope,a reticular basket was used to take out stones for patients who were shadow-positive.Re-cholangiography was then performed to ascertain that no stone was retained in the biliary tract.Results Of the 185 patients,60 were found to be positive on IOC.Stones were successfully removed by using a reticular basket through the cystic duct in 45 patients,and through the cystic duct and common bile duct after a micro-incision was made under choledochoscopic assistance in 10 patients.After laparoscopic common bile duct exploration re-cholangiography found no residual stones in these patients. In 5 patients,stones were removed after conversion to open surgery. Conclusions During laparoscopic common bile duct exploration,using reticular baskets via the cystic duct for intraoperative cholangiography (IOC) and removing stones is of great value.