胆囊切除术后发生原发性胆总管结石70例临床分析  

Primary choledocholithiasis after cholecystectomy: a clinical analysis of 70 cases

作　　者：张和平[1] 

机构地区：[1]新安县人民医院外二科,河南洛阳471800

出　　处：《临床肝胆病杂志》2014年第11期1135-1137,共3页Journal of Clinical Hepatology

摘　　要：目的：探讨胆囊切除与原发性胆总管结石的关系以及原发性胆总管结石手术治疗模式。方法收集新安县人民医院2007年1月至2013年12月收治的70例胆囊切除术后远期胆总管结石患者的临床资料，结合有关文献进行了分析。结果70例患者均行手术治疗，术中证实胆总管结石均为胆色素结石。术后并发症：切口感染8例，肺部感染5例，无胆漏、胆道出血等严重并发症，均治愈出院。胆总管结石复发8例，分别于结石复发后2．5-4年再次手术，行胆总管切开取石加胆总管离断、Roux－Y胆总管空肠吻合术治愈。结论胆囊切除术后远期发生的原发性胆总管结石，是一种老年疾病，它不是胆囊切除术后的远期并发症，胆囊切除若未发生胆道损伤，就不会增加原发性胆总管结石的发生率。原发性胆总管结石须手术治疗，对于胆总管扩张直径＞2．5cm者或复发病例，建议行开腹手术胆总管离断、Roux－Y胆总管空肠吻合术。Objective To investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis.Methods The clinical data of 70 patients with forward common bile duct stones after cholecystectomy who were admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed.Results All 70 patients underwent open surgery for removal of common bile duct stones,which were identified as bile pigment calculi.The postopera-tive complications included incisional wound infection （8 cases）and lung infection （5 cases）,and no severe complications as biliary leak-age or hematobilia were observed.All patients fully recovered at the time of discharge.Eight cases of recurrent common bile duct stones were found and surgeries were performed 2.5 to 4 years after the recurrence.All patients were cured by choledocholithotomy,common bile duct transection,and Roux-en-Y hepaticojejunostomy.Conclusion Primary choledocholithiasis is an age-related disease,not a long-term complication of cholecystectomy.If no bile duct injury occurs during the cholecystectomy,the incidence rate of primary choledocholithiasis will not be increased.Surgical treatment is required for primary choledocholithiasis.For the cases of choledochectasia with the diameter of common bile duct greater than 2.5 cm or recurrent choledocholithiasis,the laparotomy with common bile duct transection and Roux-en-Y anastomosis is recommended.

关 键 词：胆囊切除术 胆总管结石 老年病 

分 类 号：R657.4[医药卫生—外科学]