胆囊切除术后残余胆囊结石18例诊治及预防

目的：探讨胆囊切除术后残余胆囊结石的诊断、治疗和预防。方法：2001年1月-2011年1月以来，某医院共进行胆囊切除术631例，所有患者术后进行相应检查，其中18例患者因残余胆囊结石需要再次进行手术治疗，患者在距离首次手术3个月～3年后进行再次手术，术式选择剖腹残余胆囊切除。并选取同一时间段内行胆囊切除术后没有残余胆囊患者18例作为对照组，超声检查比较两组的胆总管直径。结果：残余胆囊结石的发生率为2．85％。残余胆囊组的胆总管直径为（8．1±1．02）mm，对照组的胆总管直径为（6．0±0．62）mm，两组差异具有统计学意5L（P〈0．05）。结论：胆囊切除术后患者再次出现右上腹绞痛、发热、黄疸时，应该高度警惕残余胆囊结石，并采用B超、CT等检查进行检查，若存在残余胆囊，其胆总管宽度将大于无残余胆囊患者。手术成功关键在于是否有良好的麻醉、手术野暴露和细致的解剖。

The treatment and prevention of 18 patients with remanent gallstone after cholecystectomy

Objective：To investigate the diagnosis, treatment, and prevention of remanent gallstone after cholecys- tectomy. Methods：There were 631 patients who have had cholecysteetomy in our hospital from January 2001 to Jan- uary 2011. All of them had postoperative examination. Among them, 18 need reoperation because of remanent gall- stone. They had reoperations of open remanent cholecystectomy 3 months to 3 years later after the first operation. At the same time, 18 patients who had cholecystectomy but had no remanent gallstone after operation were selected as control group. Ultrasonography was made to make a comparison of two groups＇ width of choledoch.Results：The inci- dence rate ofremanent gallstone was 2.85%. The total width ofcholedoch in remanent gallstone group was （8.1 ± 1.02）mm, while it was （6.0± 0.62）mm in control group. The variation had statistical significance.（P〈0.05）. Conclusion：When the patients who have had cholecystectomy have epigastric pain, a fever, or jaundice, we should pay attention in case of rema- nent gallstone. Patients should also have B-ultrasonic and CT. If they have remanent gallstone, their width of choledoch will be wider than others. The key factors of successful operation are good anesthesia, full exposure, and careful anatomy.