LC术后胆总管胰腺段结石残留29例临床分析.docVIP

LC术后胆总管胰腺段结石残留29例临床分析 王峻（通讯作者）张勇何涛胡洪 （玉溪市人民医院普外二科云南玉溪 653100） 【摘要】目的探讨腹腔镜肭囊切除术（LC）后肭总管胰腺段结石残留的临床特 征。方法对木院2003年1月至2012年12月29例LC术后胆总管胰腺段结石 残留患者的临床资料进行回顾性分析。结果29例患者首次手术行LC术前诊断 为肭囊结石，无肭总管探查指征。但术后发现有脶总管胰腺段结石，其中，经彩 超确诊10例，MRCP确诊19例。处理：ERCP+EST取石成功8例，开腹胆总管 切开取石14例，腹腔镜胆总管探查取石3例，保守治疗好转4例。结论LC术 后胆道结石的残留为术前和术中漏诊所致，主要受原有诊断和结石较小、数目较 少、位置隐蔽的干扰。术前检查胆囊结石细小结石，尤其是伴有肝酶升高时，最 好增加MRCP检查。术中发现胆囊颈管较粗时，最好能行术中胆道造影或胆道镜 检查。 【关键词】腹腔镜胆囊切除术胆总管结石 【中图分类号】R619 【文献标识码】A 【文章编号】2095-1752 （2013） 28-0119-02 Clinical analysis of the stone residual in CBD through pancreatic segment after laparoscopic cholecystectomy WANG Jun, ZHANG Yong, HETao, HU Hong （The Second Department of General Surgery, the peoplersquo;s Hospital of YuXi City, YuXi,丫unNan 653100, China） 【Abstract】 Objective To discuss the features of the stone residual in CBD through pancreatic segment after laparoscopic cholecystectomy. Methods Retrospective analysis was made on clinic data of 29 cases which were diagnosed as residual stones in CBD through pancreatic segment after laparoscopic cholecystectomy. Results 29 cases were diagnosed as cholecystolithiasis without indication of exploration of common bile duct before the first surgery. The residual stones was found in CBD through pancreatic segment after operation and in which 10 cases was diagnosed by Ultrasonic examination ,19 cases by MRCP. Extraction of stones was performed by ERCP+EST in 8 cases, surgery in 14 cases,3 cases by laparoscopic exploration of common bile duct and 4 cases was cured by expectant treatment. Conclusions The residual stones in CBD after laparoscopic cholecytectomy are correlated to missed diagnosis before or during surgery and the main reasons were the interference of prior diagnoses ,small and less and larvaceous stones. The B type ultrasonic diagnosis and MRCP are preferred in case of many stones in gallbladder,especially accompanied with elevated aminopherase or cholerythrin. Cholangiographic technique or choledochoscope were recommended while gross neck of g