腹腔镜胆囊切除术结石滑入胆总管致急腹痛6例分析

目的：探讨腔镜胆囊切除术（laparoscopic cholecystectomy,LC）结石滑入胆总管的原因及其所致急腹痛的诊治。方法：回顾性分析自1999年1月至2006年12月行LC时发生的6例结石滑入胆总管致急腹痛患者的临床资料。结果：三所医院共行LC3432例,发生结石滑入胆总管致急腹痛6例,发生率为0.175%。结论：萎缩性胆囊炎、胆囊充满型结石、胆囊张力过高、胆囊泥沙样结石以及胆囊管结石患者行LC时,结石容易滑入胆总管;胆囊结石滑入胆总管致急腹痛时,应首先施行保守排石治疗,若结石较大可行十二指肠乳头切开取石,若发生胆漏或急性胆管炎保守治疗无效时,应积极施行剖腹探查术。

Analysis of acute stomadache caused by the gallstones sliding into the common bile duct in laparoscopic cholecystectomy:a report of 6 cases

Objective:To analyze the reasons that gallstones slide into the common bile duct(CBD)in laparoscopic cholecystectomy(LC),and explore the diagnosis and treatment of the following acute stomadache.Methods:The data of 6 cases which gallstones slided into the CBD in LC from 1999 to 2006 were retrospectively analyzed.Results:In the 3 432 cases of LC performed in the three hospitals,there are 6 cases of acute stomadache cased by gallstones sliding into CBD.The incidence rate is 0.175%.Conclusions:The sliding gallstones into CBD easily happened in the cases of atrophic cholecystitis,gallbladder filled with stones,hypertension gallbladder of gallbladder and calculus of cystic duct.During the acute stomadache caused by the sliding gallstones,the conserve treatment should be firstly chosen;if the calculi are large,EST is a good way to take the stones out;for those cases with acute cholangitis or bile leakage,laparotomy should be actively carried out if other treatment fails.