胆道术后残余结石的治疗与预防

目的 探讨胆道术后残余结石的防治方法。方法 回顾性分析1996—2004年，经术中、术后胆道镜及胆道造影确诊的260例胆道残余结石患者，对其治疗方法及预防措施进行总结分析。结果 经T管窦道胆道镜子取石198例（76．2％），经内镜乳头气囊扩张取石（EPBD）11例，经内镜括约肌切开取石（EST）33例，Oddi括约肌切开成形术4例，胆肠Roux—Y吻合7例，肝左外侧叶切除术3例，保守治疗4例。其中1次结石取净112例，2次结石取净79例，3次以上结石取净51例，结石未取净18例（6．9％）。结论 胆道镜、十二指肠镜是治疗胆道术后残余结石的主要手段，合理选择手术方式是预防残余结石的根本措施。

Treatment and prevention to postoperative residual gallstone of biliary tract

Objective To probe the preventing and treating measures for postoperative residual gallstone of biliary tract.Methods To retrospectively analyse 260 cases diagnosed confirmly by biliary tract endoscope or biliary graphy in the course of operation or postoperation from 1996 to 2004,and make a summary of treating methods and preventing measures.Results 198 cases(76.2%) of residual gallstone were removed by biliary tract endoscope through T-tube sinus,11 cases by EPBD,33 cases by EST,oddis sphincter incision and plastic operation for 4 cases,7 cases anastomosis between biliary tract and intestine by Roux-Y,3 cases operated with left-lateral lobe of liver resection,conservative treatment for 4 patients.Among these cases,112 patients with residual gallstone were removed clearly one time,79 cases for two times,51 cases for three times,18 cases(6.9%) could not be removed completely.Conclusion Bilioscope and duodenofiberscope are the main treating methods to blilary postoperative patients with residual gallstone,to reasonably select operation program is the rational measure to prevent from resedual gallstone.