残余胆囊结石合并胆总管结石诊治分析  

Diagnosis and analysis of residual gallbladder stone with choledocholithiasis

作　　者：郑黎明[1] 蒋松松 陈刚[1] 张凯[1] 

机构地区：[1]南京大学医学院附属鼓楼医院普外科,江苏省南京210008

出　　处：《中国基层医药》2015年第21期3229-3231,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：国家临床重点专科资助项目（国家卫生部卫办医政函[2012]649号）

摘　　要：目的：探讨残余胆囊结石合并胆总管结石的诊断、漏诊原因及治疗。方法对34例残余胆囊结石患者中16例残余胆囊结石合并胆总管结石患者的临床资料进行回顾性分析。结果16例残余胆囊结石合并胆总管结石患者，其中14例行残余胆囊切除术＋胆总管探查（切开取石）＋T 管引流术，2例行胆总管探查＋T 管引流术，术前漏诊残余胆囊结石率56．3％（9／16），7例患者术中发现残余胆囊结石，另2例漏诊残余胆囊结石，术中及术后漏诊率12．5％（2／16）；18例残余胆囊结石患者，其中16例行残余胆囊切除术，2例因可疑胆总管结石的患者术中行残余胆囊切除术＋胆总管探查＋T 管引流术，术前及术后无漏诊。结论残余胆囊结石合并胆总管结石的临床症状与残余胆囊结石相似，常表现为右上腹痛、发热、寒战、黄疸、腹胀等症状，术前影像学检查较难发现小于3 cm 的残余胆囊及其小结石，当同时合并胆总管结石时，更需要术中仔细解剖胆囊管及胆总管，做好胆囊管及胆总管的探查，减少漏诊残余胆囊结石。Objective To investigate the diagnosis/misdiagnosis reason/treatment of residual gallbladder stone with choledocholithiasis.Methods The clinical data of 34 patients with residual gallbladder,16 cases of them suffered from choledocholithiasis additionally were retrospective analyzed.Results 14 cases were treated by residual cholecystectomy ＋choledochotomy ＋T -tube drainage,2 cases were were treated by choledochotomy ＋ T -tube drainage.Preoperative misdiagnosis of residual gallstones rate was 56.3% （9 /16 ）,7 cases were found residual gallstones during operation.The other 2 cases were misdiagnosed residual gallstones.The rate of intraoperative and postoperative misdiagnosis was 12.5% （2 /16 ）.18 cases with residual gallstones,16 cases underwent residual cholecystectomy,2 cases who were suspected with choledocholithiasis underwent residual cholecystectomy ＋choledo-chotomy,T -tube drainage.18 cases had no preoperative and postoperative misdiagnosis.Conclusion The clinical symptom of residual gallbladder stone with choledocholithiasis was similar to residual gallstones,often characterized by upper abdominal pain,fever,chills,jaundice,abdominal distension and other symptoms.It is difficult for preoperative imageological diagnosis that less than 3 cm residual gallbladder and small stones.When choledocholithiasis at the same time,needing more intraoperative careful dissect cystic duct and common bile duct,completes the cystic duct and common bile duct exploration,reducing misdiagnose residual gallstones.

关 键 词：胆结石 胆总管结石 诊断 治疗 

分 类 号：R657.42[医药卫生—外科学]