胆囊切除术后残余胆囊结石56例诊治及预防

The prevention,diagnosis and treatment of the cholelith in residual gallbladder after cholecystectomy

目的：探讨胆囊切除术后残余胆囊结石的诊治和预防方法，减低此并发症的发生率。方法：对56例残余胆囊结石再次手术的病例进行回顾性分析。56例中初次手术行经典胆囊切除术18例，小切口胆囊切除术16例，腹腔镜胆囊切除术22例；急诊手术30例，择期手术26例；初次手术在三级以下医院施行42例，在三级以上医院施行14例。结果：除1例因粘连严重并发门脉高压症，分离时引起大出血被迫终止手术外，55例再次手术成功，切除残留胆囊及结石后，症状均消失，疗效满意。结论：合理掌握胆囊切除术的手术时机、和术式，在术中解剖清楚胆囊管、肝总管、胆总管三管关系，然后距胆总管0．3～O．5cm切断结扎胆囊管，是预防残余胆囊结石的关键。

To investigate the prevention, diagnosis and treatment of cholelith in residual gallbladder after cholecystectomy so as to reduce morbidity of cholelith in residual gallbladder. Methods： Fifty-six cases of cholelith in residual gallbladder after cholecystectomy were analysed retrospectively. Among them, 18 patients under went conventional cholecystectomy（CC）, 16 patients underwent mini-lap cholecystectomy（MC）, 22 patients underwent laparoscopic cholecystectomy（LC）; 30 patients under went emergency operation and 26 patients under went selective operation; 42 patients＇ first operation was performed by under grade three hospital and 14 patients were performed by up grade＇ three hospital. Results： All these patients under went the second laparotomy, the residual gallbladder and cholelith were excised successfully in 55 cases, 1 case was unsuccessful because of severe adhesion and bleeding. After successful operation, the symptoms disappeared and the results were satisfactory. Conclusion： To prevent cholelith in residual gallbladder, it is important to choose the proper timing and mode of cholecystectomy, to anatomize cystic duct, common hepatic duct, common duct clearly and cut cystic duct 0.3-0.5cm apart from common duct.