胆总管结石残留的因素分析及防治

目的 探讨胆囊结石胆囊切除术后胆总管结石残留的原因及处理方法。方法 1994年1月2000年9月间1027例胆囊结石病人在我院施行胆囊切除术，同时行胆总管切开探查术者246例，证实有胆总管结石者205例；对其中14例术后胆总管结石残留患者的临床资料进行对比分析。结果 结石残留组病人的76％为60岁或以上，64％并发急性胆管炎，50％术中取出胆总管结石3－5枚，仅14％行术中纤维胆道镜探查取石，与无结石残留病人相比差异均有显著性意义（P＜0．05）。13例残留结石经术后胆总管T管造影发现并分别行1－2次术后纤胆镜取石后完全清除；另1例自然排出。结论 胆总管结石残留多发生于年龄较大、胆总管结石较多、并发急性胆管炎的患者；术中纤胆镜的应用有助于防止结石残留。胆总管T管造影能可靠地诊断残留结石。术后经T管瘘道纤胆镜取石是治疗残留结石安全有效的方法。

Clinical analysis and management of retained common bile duct stones

Objective To investigate the risk factors and management of retained common bile duct stones.Method The clinical data of 14 patients with retained common bile duct stones between 1994 and 2000 was statistically analyzed in comparison with 191 patients of the negative postoperative T tube cholangiography. Results Common bile duct stones were present in 20% of patients undergoing cholecystectomy. In 7% of patients, stones were left in the bile ducts after common bile duct exploration. Statistically significant difference was observed in the age of the patient population, the percentage of associated acute cholangitis, the number of the stones present in common bile duct and the frequercy of the intraoperative choledochoscopy when compared retained bile duct stones with negative postoperative T tube cholangiography. Conclusions Retained common bile duct stones is related to age of the patient, the association of acute cholangitis, the number of the common bile duct stones and the operative choledochoscopy. Postoperative flexible choledochoscopy or endoscopic papillotomy is an effective method for managing patients with retained common bile duct stones.