腹腔镜胆囊切除术后胆总管残留结石的防治

目的：探讨基层医院腹腔镜胆囊切除术后胆总管残留结石的原因及对策。方法：对腹腔镜胆囊切除术后胆总管残留结石13例患者的Il盘床资料进行回顾性分析。结果：13例患者术前均诊断为单纯胆囊结石，胆囊内伴有多发性小结石，均有右上腹或剑突下疼痛病史，1例转氨酶升高，3例伴胆囊颈部结石嵌顿，胆总管增粗2例，所有患者术前均未行MRCP检查。行腹腔镜胆囊切除术后因出现不适症状发现胆总管结石，其大小与胆囊内小结石相当，6例经保守治疗结石自行排出，7例手术治疗治愈。结论：详细复习病史资料，及时补充检查，正确的操作方法是预防此并发症的关键。采用保守治疗可使部分结石自行排出，EST治疗为首选手术方式，必要时开腹手术。

Prevention of residual common bile duct stones after laparoscopic cholecystectomy

Objective：To evaluate the causes and treatment countermeasure for residual common bile duct stones after laparoseopic eholecystectomy （LC） in primary level hospital. Methods：The clinical data of 13 cases of residual common bile duct stones after LC were retrospectively analyzed. Results：Preoperative of 13 cases were diagnosed as pure gallstones associated with multiple small stones in the gallbladder. All patients have a history of pain in right upper belly or below xiphoid. One case accompanied with elevated aminotransferase; 3 cases with gallbladder calculi incarceration; enlargement of common bile duct in 2 cases and all patients without preoperative MRCP examination. Common bile duct stones which have the equal size with the small stones in the gallbladder were found after LC due to discomfort symptoms. Six cases with conservative treatment and 7 cases of surgical treatment were all cured. Conclu- sion： The key to prevent the complications is detailed review of history information, timely replenishment of examina- tion and the correct method of operation.Conservative treatment can make part of the stones expelled while EST is the first choice when laparotomy operation is necessary.