腹腔镜胆囊切除术后残株胆囊及胆囊管结石

目的探讨腹腔镜胆囊切除术后残株胆囊／胆囊管结石的原因、诊断、处理及预防方法。方法回顾总结我院 1992-2005年间收治的8例腹腔镜胆囊切除术后残株胆囊／胆囊管结石病例的临床资料。结果 8例病人术前经B超、MRI、 ERCP检查确诊后,均经再次手术治愈。残株胆囊结石2例;残株胆囊管结石6例,其中2例合并胆总管结石;2例行残余胆囊切除术,6例行残株胆囊管切除、其中4例附加胆总管切开探查和／或取石、T型管引流。随访1．1-13年,效果良好。结论判断失误是腹腔镜胆囊切除术后残株胆囊结石的主要原因,过长的炎性及畸形的胆囊管残留是腹腔镜胆囊切除术后残株胆囊管结石的主要原因;其症状和体征类似于结石性胆囊炎、合并胆管结石时可有黄疸;B超、CT、ERCP等检查可确诊;再次手术切除(或取出)残株胆囊／胆囊管(结石)是有效可靠的治疗方法;娴熟的腹腔镜技术、术中胆道造影、正确掌握中转开腹指征以及丰富的胆道外科经验是预防其发生的关键。

RETAINED GALLBLADDER/CYSTIC DUCT REMNANT CALCULI AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Objective To explore the reasons, diagnosis, management and prevention of retained gallbladder/cystic duct remnant calculi after laparoscopic cholecystectomy. Methods Clinical data of 8 cases of retained gallbladder/cystic duct remnant calculi after laparoscopic cholecystectomy in our hospital during 1992-2005 were retrospectively analyzed. Result All the 8 patients were cured by reoperation after accurate preoperative diagnosised by the introduction of Bus, MRI, or ERCP. 2 cases of which diagnosised retained gallbladder were cured by resection of retained gallbladder; 6 cases of which diagnosised cystic duct remnant calculi were cured by resection of a cystic duct,4 cases pulsed common bile duct exploration and T-tube drainage. All patients had good results during the follow-up ranging from 1. 1 years to 13 years. Conclusion The main causes for retained gallbladder calculi after laparoscopic cholecystectomy is incorrect identification and the cystic duct remnant calculi's is a long inflammation and/or abnormal cystic duct remnant calculi; it's clinical presentation is similar to that of cholecystitis with gallstones,partly also has associated jaundice;This entity can be identificated by the combined intro- duction of Bus, MRI, or ERCP and cured by laparotomy and resection of a retained gallbladder and/or cystic duct;skilled laparoscope technique .intraoperative cholangiography,precise treatment about converting to open operation and rich surgery experiences are the key to prevention of this entity.