残余胆囊结石6例诊治分析

目的 探讨残余胆囊结石的原因、诊治及预防。方法 回顾性分析绍兴市人民医院2016年10月至2019年12月收治的6例残余胆囊结石患者的临床诊治经过，分析其发生原因，探讨诊治方法及预防措施。结果 6例残余胆囊结石患者中，2例行腹部B超检查，其中1例证实为残余胆囊结石；所有患者行腹部增强CT检查，均证实为残余胆囊结石；3例患者行MRCP检查，其中2例确诊，1例未发现明显异常。6例残余胆囊结石患者中，2例行腹腔镜残余胆囊切除术，2例行腹腔镜中转开腹残余胆囊切除加胆总管探查T管引流术，1例行腹腔镜中转开腹残余胆囊切除术，1例拒绝手术治疗。5例手术患者均治愈出院，随访4～43个月，平均（19.8±14.7）个月，无结石复发情况。结论 增强CT在残余胆囊结石的诊断中具有重要价值。腹腔镜手术可作为首选的治疗方法。残余胆囊结石是多因素共同作用的结果，合理的手术方案，必要的手术技巧，良好的手术心态，及时中转开腹的意识对预防残余胆囊结石发生尤为重要。

Diagnosis and treatment for residual gallbladder stones in 6 cases

Objective To discuss the causes, diagnosis, treatment and prevention of residual gallbladder stones (RGS). Methods The clinical data of 6 patients with RGS admitted in Shaoxing People’s Hospital between Oct. 2016 and Dec. 2019 were analyzed retrospectively. Results Among the 6 RGS patients, 2 patients received B-ultrasonography, of which 1 patient was diagnosed as RGS; all 6 patients received abdominal enhanced CT scan and were confirmed as RGS; 3 patients received MRCP, of which 2 patients were diagnosed as RGS. Among the 6 RGS patients, 2 cases received laparoscopic residual cholecystectomy; 2 cases converted to open residual cholecystectomy plus common bile duct exploration, 1 case converted to open residual cholecystectomy, and 1 case refused the operation. Five operative cases were cured uneventfully and no stone reoccurred during the follow-up period (4~43 months). Conclusion Contrast-enhanced CT scan has significant value for RGS diagnosis. Laparoscopic approach can be considered as the first choice for RGS treatment. The occurrence of RGS is multifactorial, appropriate surgical approaches, imperative surgical skills, good surgical mentalities, and the awareness of open transformation are feasible for prevention of RGS.