胆囊结石合并黄疸329例临床剖析.docVIP

胆囊结石合并黄疸329例临床剖析 　　[摘要] 目的：旨在提高胆囊结石伴黄疸患者的诊断和治疗水平。方法：回顾性分析1997～2006年我院收治的胆囊结石伴黄疸329例的临床资料。结果：208例有典型的急性化脓性胆管炎表现者中，行胆囊切除及胆总管探查、“T”型管引流术者102例；经内窥镜行Oddi括约肌切开、鼻胆管引流，然后行胆囊切除及胆总管探查、“T”型管引流术者56例；经内窥镜治疗后胆总管结石排出而行胆囊切除术者50例。121例无典型化脓性胆管炎表现者中行胆囊切除及胆总管探查、“T”型管引流术者24例；经内窥镜行鼻胆管引流，然后行胆囊切除术者56例；经胆囊管行术中胆道造影显示胆管无异常，行胆囊切除术者21例；先行保守治疗，黄疸消退后再行胆囊切除术者16例；单纯行胆囊切除术后黄疸加重在内窥镜下行鼻胆管引流者4例。结论：当胆囊结石并发梗阻性化脓性胆管炎时，多行胆囊切除和胆总管探查术，或先在内窥镜下行Oddi括约肌切开及鼻胆管引流术，然后行胆囊切除术或同时行胆总管探查术，首要目的均是尽快进行胆道减压和引流，以解除胆道梗阻。胆囊结石伴黄疸但无典型化脓性胆管炎表现时，不宜轻易地行胆囊切除术，应充分应用包括逆行胰胆管造影在内的影像学检查仔细调查胆道情况，恰当选择鼻胆管引流和胆总管探查术，以获得理想的治疗效果。 　　[关键词] 胆囊结石；黄疸；诊断；治疗 　　[中图分类号] R657.4+2[文献标识码]C [文章编号]1673-7210（2008）11（c）-027－02 　　 　　Clinical analysis of 329 cases of cholecystolithiasis accompanied with jaundice 　　MA Rui-liang, BAI Jian-ping, QIN Da-wei, LU Hui 　　(Department of General Surgery, 254th Hospital of PLA, Tianjin300142, China) 　　[Abstract] Objective: To improve the outcome of treatment for cholecystolithiasis accompanied with jaundice. Methods: To retrospectively analyze the clinical data of 329 cases of cholecystolithiasis accompanied with jaundice managed in our hospital from 1997 to 2006. Results: Among 208 cases of cholecystolithiasis accompanied with jaundice and acute cholangitis, 102 cases underwent cholecystectomy and choledochotomy, 56 cases underwent postendoscopic sphincterotomyand nasobiliary drainage, then cholecystectomy and choledochotomy, the other 50 cases underwent postendoscopic sphincterotomy and nasobiliary drainage， then cholecystectomy. Among 121 cases of cholecystolithiasis accompanied with jaundice but without acute cholangitis, 24 cases underwent cholecystectomy and choledochotomy, 56 cases underwent endoscopic nasobiliary drainage and then cholecystectomy, 21 cases underwent cholecystectomy with normal result of operative cholangiography, 16 cases underwent cholecystectomy after jaundice disappeared by treatment of internal medicine. 4 cases with aggravated jaundice after cholecystectomy underwent endoscopic nasob