摘要
目的探讨胆囊切除术后残留胆总管结石的临床特点和腹腔镜手术的疗效。方法回顾性分析2015年1月～2017年12月笔者医院收治的14例胆囊切除术后残留胆总管结石患者,分析其临床表现、既往手术史、实验室检查、影像学表现和手术相关指标。结果 14例患者首次出现症状与初次手术间隔时间为1～22个月,中位间隔时间为11个月。其中9例以右上腹疼痛伴恶心、呕吐、发热为主要症状,5例以梗阻性黄疸为主要表现,且有2例患者并发急性胰腺炎。既往8例为择期腹腔镜手术,4例为急诊腹腔镜手术,2例为急诊开腹手术。12例次谷丙转氨酶、谷草转氨酶升高,5例次总胆红素、直接胆红素升高,2例次血、尿淀粉酶及脂肪酶升高。所有患者均经过MRCP检查证实胆总管结石。所有患者无中转开腹病例,术后无严重并发症发生。手术时间75～164min,中位手术时间90min;手术出血量15～154ml,中位出血量48ml;术后住院时间5～14天,中位住院时间7天。结论患者胆囊切除术后原症状不缓解或再次出现类似症状时,甚至发热、黄疸、并发急性胰腺炎时均应考虑胆总管结石残留可能,且腹腔镜手术治疗残留胆总管结石安全而有效。
Objective To explore the clinical features and laparoscopic management of residual choledocholithiasis after cholecystectomy.Methods The clinical data of 14 patients with re residual choledocholithiasis after cholecystectomy from Jan.2015 to Dec.2017 were reviewed.These patients′clinical manifestation,previous surgical history,laboratory examination,imaging examination and indexes related to surgery were analyzed.Results Initial clinical manifestation occurred at 1-22 months(median,11 months).Among 14 cases,9 cases had right upper abdominal pain with nausea,vomiting and fever,and 5 cases had obstructive jaundice.In additional,2 cases complicated with acute pancreatitis.All the patients had histories of cholecystectomy,including 8 cases with elective laparoscopic cholecystectomy,4 cases with emergency laparoscopic cholecystectomy and the other 2 cases with emergency open cholecystectomy.12 cases with elevated alanine transaminase and aspartate transaminase,5 cases with elevated total bilirubin and direct bilirubin and 2 cases with elevated serum and urinary amylase and lipase were detected.These 14 cases had positive results of MRCP.No patient was transferred to open procedure and had severe complications.The operation time,blood loss and hospital stay were 75-164min(median,90min),15-154ml(median,48ml),5-14days(median,7days)respectively.Conclusion When the symptoms after cholecystectomy are not relieved or similar symptoms occur again,even with fever,jaundice,acute pancreatitis,the residual choledocholithiasis should be considered.Laparoscopic procedure for residual choledocholithiasis is safe and feasible.
作者
熊良昆
马鹏
汪茂鸣
刘浩
余开焕
Xiong Liangkun;Ma Peng;Wang Maoming(Department of General Surgery,the Eastern Hospital of Renmin Hospital of Wuhan University,Hubei 430060,China)
出处
《医学研究杂志》
2019年第3期120-123,共4页
Journal of Medical Research
关键词
残留胆总管结石
胆囊切除术
腹腔镜
Residual choledocholithiasis
Cholecystectomy
Laparoscopy
