结石性残株胆囊炎的诊治体会:附36例报告

目的：探讨结石性残株胆囊炎的原因、诊断及手术治疗方法。方法：对36例经手术证实的结石性残株胆囊炎的临床资料进行回顾性分析。结果：36例均经再次手术治愈,其中残株胆囊切除8例,残株胆囊切除、胆总管切开探查或／和取石、T管引流28例。31例（86．1％）获随访,随访3个月－12年,效果优良率为93．5％。结论：引起结石性残株胆囊炎的主要原因行胆囊切除术时是未遵循辨“辨切辨”三字程序。其主要症状和体征与结石性胆囊炎相似。诊断上各项辅助检查的准确率不高,必须对各项检查进行综合分析。治疗上必须遵循“辨切辨”三字程序,先切开胆总管、肝总管,再切除残株胆囊。

Diagnosis and treatment of residual cholecystitis with gallstones:a report of 36 cases

Objective To explore the reasons,diagnosis and treatment of residual cholecystitis(RCC) with gallstones. Methods The clinical data of 36 RCC patients with gallstones identified by operation were retrospectively analyzed. Results All the 36 patients were cured by reoperation. Residual cholecystectomy was performed on 8 patients, and residual cholecystecomy plus common bile duct exploration and T tube drainage on 28 patients. Thirty one patients were followed up for 3 months to 12 years,93.55% of the patients had good results. Conclusions The main reason of residual cholecystitis with gallstones was not followed the principle of "identify cut identify" during cholecystectomy .The clinical presentation of RCC is similar to that of cholecystitis with gallstones .The accurate rate of auxiliary examinations is low,so the results of these exammations should be analyzed comprehensivly in the diagnosis. The principle of "identify cut identify" should be followed during the reoperation. The common bile duct and common hepatic duct should be opened first and then the residual gall be resected.