42例胆囊切除术后症状复发原因探讨

APPROACH OF RECURRENT SYMPTOMS FOLLOWING CHOLECYSTCETOMY (ANALYSIS OF 42 CASES)

１９８４年１０月～１９９２年６月对胆囊切除术后又出现胆系症状４２例患者行ＥＲＣＰ、Ｂ超声、ＰＴＣ、胆道造影检查，发现器质性病变者４１例。复发原因有：胆系结石１９例（４５．２％）；胆总管狭窄１１例（２６．２％），其中８例合并结石；残留胆囊管过长５例（１１．９％），其中３例合并结石；慢性胰腺炎４例（９．５％）；胆总管十二指肠瘘２例（４．５％）。认为胆囊切除患者术前应做胆道造影、ＥＲＣＰ、Ｂ超等检查，详细了解病变部位，术中仔细探查或加做胆囊造影，减少结石残留及术中损伤，可降低胆囊术后复发率。

Recurrent symptoms following cholecystectomy are also termed as postchole-cystectomy syndrome. Because majority of those was originated from organic illness,soit is seggested that it is better to be called recurrent symptoms following cholecystec-tomy. From 1984 to 1992, 42 patients with recurrent symptoms by use of ERCP,PTC andultrasonography in which 41 cases had abnormal findings, which include residual or recur-rent calculi in extra or intrahepatic bile ducts: 19 cases(45.2%)local stricture in the com- mon bile ducts :11 cases(26.2%)and eight accompanied bile stones. Cystic duct rem- nants : 5 cases(11.9%)and three accompanied bile stones. Chronic pantreatitis: 4 cases(9.5%)and cholangioduodenal fistula :2 cases(4.5%).The conclusion is that, to reducethe recurrent symptoms following cholecystectemy,ERCP and ultrasonography or otherexaminatons should be done to make definite diagnosis befere operations; and doing care-fully ,sometimes cholangiography may be necessary during operation to avoid injury andincomplete surgery.