胆石病术后结石复发的原因及防治

Causation and prevention of concretion recrudescent after cholelithiasis operation

目的探讨胆石病术后结石复发的原因及防治。方法对68例胆石病术后再次出现结石患者行逆行胰胆管造影术(ERCP),同时测量胆管远端生理狭窄段(NDS)长度、观察Odd i括约肌蠕动方向、十二指肠乳头附近憩室以及胆管的其他情况。结果68例患者中NDS长度≥10mm者46例,Odd i括约肌蠕动方向异常者42例,十二指肠乳头附近有憩室者27例,胆囊管残端过长6例,放置T管后胆管良性狭窄9例。结论胆石病术后结石复发与Odd i括约肌蠕动方向异常、NDS长度过长、十二指肠乳头附近有憩室、胆囊管残端过长、放置T管后胆管良性狭窄密切相关;胆石病术后再次出现结石首选内镜下十二指肠乳头切开术(EST)取石。

Objective To discuss the causation and prevention of concretion recrudescent after cholelithiasis operation. Methods Do the endoscopid retrograde cholangiopancreatography （ERCP） on the 68 cases who represent the concretion after having cholelithiasis operation. At the same time, measuring the length of narrow distal segment（ NDS）, observing the squirm direction of Oddi constrictor, diverticulum＇s nearby duodenum papilla and observe the other circumstances of bile duct. Results Among the 68 sufferers, there were 46 cases of NDS length ≥ 10mm,42 cases of Oddi constrictor squirm the abnormity direction, 27 cases of duodenum papilla nearby have diverticulum,6 cases that choleeyst duct nub was unduly long,9 cases have bile duct were benign striates after placing the T tube. Conclusion Concretion recrudescent after cholelithiasis operation is osculating relevantly with the over long length of NDS and choicyst duct nub, abnormally squirm direction of Oddi constrictor, and the benign striates ＇after placing the T tube,if the concretion represent after the eholelithiasis operation, initial use endos EST get cholelith.