摘要
目的总结分析胆囊管结石漏诊的原因及术后胆管结石的中西医结合预防。方法回顾性分析我院2008年1月—2013年12月166例术前及术中诊断为胆囊管结石患者的临床资料,对患者的一般资料,手术情况,术后并发症及术后中西药结合预防胆管发生结石的情况进行统计学分析。结果 166例胆囊管结石患者术前全部行腹部B超检查,确诊胆囊管结石76例(阳性率46%)。全部患者均顺利完成手术,无围手术期死亡患者。术后胆囊管残余结石3例,腹腔出血1例,胆漏1例,右肝管损伤1例,戳孔感染2例。术后随访1-5年,随访期间,13例患者术后胆管再发结石,中西医联合治疗组1例(1.8%),单纯西药组4例(7%),不能坚持用药组8例(16%),行ERCP治疗9例,开腹手术胆道探查取石4例。结论胆囊管结石术前确诊困难、确诊率低,容易漏诊,术中如果没有及时发现和妥善处理,容易导致胆囊管结石残留,给患者带来痛苦和经济负担,中西医结合可以减少胆管结石的发生。
Objective To summarize and analyze the reason of preoperative misdiagnosis of calculus in cystic duct, and explore the pre-vention and treatment of calculus in cystic duct with integrated medicine. Methods We retrospectively analyzed the clinical data of 166 calculus in cystic duct patients in PLA General Hospital between January 2008 and December 2013. The general data, operation data, postoperative complications and prevention and treatment with integrated medicine information of the patients were statistical analyzed. Results All of the 166 patients underwent abdominal ultrasound examination before operation, and 76 cases were diagnosed of cystic duct stones （ positive rate was 46%） . All patients were successfully completed the operation, and no patient dead during the perioperation. Three patients had remnant calculus in cystic duct after the operation, one case of abdominal hemorrhage, one case of bile leakage, one case of right hepatic duct injury, and two cases of incision infection. During the 1-5 years of follow‐up, 13 patients had recurrence of cal-culus in cystic duct. There were one （1.8%） case in the integrated medicine group, 4 （7%） cases in the only western medicine group, and 8 （16%） cases in cannot adhere to medication group. Nine patients underwent ERCP treatment and four patients underwent abdomi-nal operation. Conclusion The calculus in cystic duct is difficult to be diagnosed before operation and the diagnosis rate is low. If it is misdiagnosis, it will easy to cause the calculus remain in the cystic duct, and bring pain and economic burden to patients. The integrated medicine can reduce the occurrence of bile duct stone.
出处
《中国中医药现代远程教育》
2015年第6期20-22,共3页
Chinese Medicine Modern Distance Education of China
关键词
胆囊管结石
结石残留
胆管结石再发
中西医结合疗法
calculus in cystic duct
retained stone
recurrence of calculus in cystic duct
therapy of integrated medicine
