摘要
目的:探讨腹腔镜胆囊切除术(LC)后残留胆道结石的原因、诊断、预防、处理等。方法:回顾分析LC术230例,LC术后发现残留胆总管结石32例的临床资料。结果:32例于LC术后出现腹痛、黄疸或发热、胆汁性腹膜炎等症状;腹痛症状最早于术后第3天出现,最迟为术后90天。31例病人术前无MRCP和ERCP检查,术中也无胆道造影;1例术前有MRCP检查。26例为急诊手术;6例是择期手术。10例采用保守治疗排石;14例行十二指肠乳头切开术(EST)后取石;6例行气囊扩张十二指乳头扩约肌后取石;2例再次行开腹胆总管探查取石引流术,全部治愈。结论:LC术后出现发烧,上腹痛,要警惕胆道残留结石可能。治疗此并发症可根据病情,结石大小和医院设备条件采用EST、ESWL和再次胆道切开取石。预防此并发症的发生在于术前正确的B超诊断和必要的ERCP、MRCP检查等,做出正确的术前判断以确定适当的手术方式。
Objective：To discuss the causes,prevention and treatment of residual stones in bile duct after laparoscopic cholecystectomy（LC）.Methods：The clinic data of 32 cases with residual stones found out of 230 cases with LC were retrospectively analyzed.Results：2 cases have been found residual stones after operation from 3 days to 90 days.There were 31 patients with ERCP or MRCP preoperatively,without biliary contrast imaging during operation and 1 case with MRCP.There were 26 cases for emergency operation and 6 cases for elective surgery,10 cases were conservatively treated to discharge the residual stones;14 cases were dealt with EST,6 cases of celiotomy esploration and drainage of the CBD were done.32 cases were all cured.Conclusions：The methods of prevention of the complication are correct diagnosis and essential examination before operation,and correct operation method were chosen.
出处
《川北医学院学报》
CAS
2011年第4期321-322,共2页
Journal of North Sichuan Medical College
