37例腹腔镜胆囊切除术后胆管残留结石的预防与处理  

Prevention and management of residual stones in the bile duct following laparoscopic cholecystectomy

作　　者：许先军 何芳芳 詹善余 潘文[1] XU Xianjun;HE Fangfang;ZHAN Shanyu;PAN Wen(Department of General Surgery,Ningguo Municipal People＇s llospital,Ningguo 242300,China)

机构地区：[1]宁国市人民医院普外科,安徽宁国242300

出　　处：《皖南医学院学报》2018年第5期462-464,共3页Journal of Wannan Medical College

摘　　要：目的:探讨腹腔镜胆囊切除术(LC)后残留的胆管结石形成的原因、预防及处理方法。方法:对我院LC术后出现胆管残留结石37例的临床资料进行回顾性分析。结果:37例患者均为胆囊多发性结石,残留结石直径2～12 mm,其中胆囊管残留结石6例,胆总管残留结石24例,胆囊管及胆总管残留结石7例。胆囊管直径3～5 mm,胆总管直径6～15 mm。15例行ERCP+EST,11例行胆总管切开取石+T管引流术(腹腔镜7例,开腹4例);胆囊管残留结石6例行腹腔镜下胆囊管切除术,成功4例,中转开腹2例; 5例保守治疗结石排出,患者全部治愈。结论:LC术后胆管残留结石预防的关键在于正确的术前评估和术中规范的操作;胆总管探查+T管引流术以及EST是处理胆管残留结石的主要方法。Objective ：To investigate the causes, prevention and management of residual calculus in the bile duct after laparoseopie eholeeysteetomy（LC）. Methods ：The clinical data were retrospectively analyzed in 37 cases of residual stones in the bile duct following LC. Results ：The 37 patients were associ- ated with multiple stones in gallbladder, and the stone diameter ranged from 2 to 12 mm. Residual stones oeeurred in the gallbladder in 6 patients,in commnon bile duct in 24,and in both gallbladder and common bile duct in 7. The residual stones in the bile duct measured from 3 to 5 mm in diameter,and in the common bile duct from 6 to 15 ram. Fifteen patients received endoscopic retrograde eholangiopancreatography （ERCP） ＋endoscopic sphineterotomy （EST） ,and 11 were treated with eholedoeholithotomy ＋T-tube drainage （7 by laparoseopy, and 4 by laparotomy）. Four of the 6 patients with residual stones in the cystic duct were successfully treated by laparoseopie eholeeysteetomy, and another 2 were converted to laparotomy. Five patients received con- servative treatment, and all patients were cured. Conclusion ： The key to successful prevention of the residual stones in the bile duct following LC relies on right preoperative assessment and standard operation. Exploration of the common bile duct plus T-tube drainage and EST are the major options for treatment of residual stones in the bile duct.

关 键 词：腹腔镜 胆囊切除术 胆管结石残留 

分 类 号：R657.42[医药卫生—外科学]