胆道术后结石残留28例临床分析

The Clinical Analysis on 28 Cases With Residual Stones After Cholecystectomy and Common Duct Exploration

目的：探讨胆道术后结石残留的原因、预防及治疗方法。方法：回顾性总结分析胆道术后结石残留28例患者的临床资料。结果：行单纯胆囊切除术后10例发生残石。行胆囊切除术及胆总管探查术18例发生残石；其中16例放置T管，2例因胆总管下端不通同时行胆总管十二指肠吻合术（未放置T管）；6例行术中胆道造影术，所有病例均未行术中纤维胆道镜检查；术后2个月内行T管造影16例，其中14例发现残石；术后3周～1年重新出现症状8例，其中B超检查发现残石2例；CT及MRCP发现残石6例；4例无症状，而B超复查发现肝内胆管残石。结论：术前检查不够完整，术中探查不够彻底以及缺乏术中胆道造影和胆道镜检查，是残石发生的主要原因。术前应综合运用影像学检查，术中应系统探查，适时地应用术中胆道造影和胆道镜，是预防残石发生的有效方法。可根据残石的部位和大小、有无T管和合并症以及治疗的条件。来选择残石的处理方法。

Objective：To investigate the reason, prevention and treatment of residual stones after cholecystectomy and common duct exploration. Methods： The clinical course of 28 patient with residual stones after cholecystectomy and common duct exploration were analysed retrospectively. Results： The 10 cases after cholecystectomy and 18 cases after cholecystectomy and common duct exploration took place residual stones. In these 18 cases. 16 cases were inserted T tube, 2 case were performed choledochoduodenostomy and 12 cases were performed cholangiography during operation, none of them performed the choledochoscope during operation;A postoperative cholangiogram through the T tube was performed in 16 cases during 2 months after operation, in which 14 cases were revealed the residual stones. Symptoms reoccurred during 3 weeks - 1 year after operation in 8 cases, in which 2 cases residual stones were showed bv B-ultrasound scans and 6 cases were seen bv CT and MRCP, 4 cases has not any symptoms but were discovered residual stones in intrahepatic ducts by B - ultrasound scans. Conclusion： It was the major reason of residual stones that uncompleting of examination before operation and exploration during operation and loss of intraoperative cholangiography and choledochoscope. It was an effective method of prevention of residual stones that diagnostic examination before operation, systemic exploration and application of cholangiography, choledochoscope and ultrasound during operation.