【摘要】 目的:探索选择性腹腔镜术中胆道造影在湖州市基层医院推广的必要性及可行性。方法:2014年1月至2014年12月1 208例腹腔镜胆囊切除术患者中120例行选择性腹腔镜术中胆道造影,对比湖州市中心医院(三级甲等医院)与基层医院(三级乙等-二级甲等)胆道造影结果,如操作时间、造影阳性结果率等,对比分析基层医院往年残余结石发生率、胆道损伤率等。结果:113例患者造影成功,造影检出残余结石(三级甲等医院8例,基层医院18例)、发现胆道损伤(三级甲等医院1例,基层医院6例),前者基层医院明显高于三级甲等医院,后者无明显差异。2014年基层医院胆道损伤及残余结石发生率均较2013年显著降低。造影所需时间基层医院长于三级甲等医院,造影成功率方面三级甲等医院与基层医院差异无统计学意义。结论:选择性腹腔镜术中胆道造影技术简单、安全,可有效降低残余结石及胆道损伤发生率,值得在不具备MRCP及ERCP技术的基层医院开展推广。更多还原

【Abstract】 Objective: To explore the necessity and feasibility of generalizing selective laparoscopic intraoperative cholangiography( LIOC) in the primary hospitals in Huzhou city. Methods: From Jan. 2014 to Dec. 2014,1 208 patients underwent laparoscopic cholecystectomy,in them 120 cases of selective LIOC were performed. The cholangiography results such as operation time,the positive results of cholangiography were compared between Huzhou center hospital( Grade Ⅲ Class A hospital) and primary hospitals( GradeⅢ Class B hospital-Grade Ⅱ Class A hospital). And bile duct injury and retained calculus between 2013 and 2014 in primary hospitals were compared. Results: The successful cases of selective LIOC were 113. There were 8 cases of retained calculus and 1 case of bile duct injury in Huzhou center hospital and 18 cases of retained calculus and 6 cases of bile duct injury in primary hospitals. The ratio of retained calculus was remarkablely higher in primary hospitals than in Huzhou center hospital. On the contrary the ratio of bile duct injury was not significantly different. The ratios of bile duct injury and retained calculus were remarkable lower in 2014 than in 2013 in primary hospitals. The successful ratios of selective LIOC were not significantly different between Huzhou center hospital and primary hospitals. But the time of selective LIOC was longer in primary hospitals than in Huzhou center hospital. Conclusions: Selective LIOC is simple and safe,and it could effectively reduce the ratios of bile duct injury and retained calculus and is worthy of generalization in primary hospitals without MRCP and ERCP.更多还原