残留胆囊结石的再认识

RE-RECOGNIZATION ON THE RESIDUAL CHOLECYST WITH GALLSTONES

目的探讨残留胆囊结石的原因及诊治策略。方法对48例经手术证实的残留胆囊结石的临床资料进行回顾性分析。结果48例均经再手术治愈，随访1-7年，无远期并发症。结论引起残留胆囊结石的原因主要是术中对胆囊管解剖辨认的误差，其症状和体征与初发胆囊结石相似，诊断中应警惕残留胆囊结石的可能性，强调在首次手术中仔细辨认胆囊管十分必要，再次手术是治愈残余胆囊结石的有效手术。

Objective To investigate the reasons of residual cholecyst with gallstones and to explore the way to diagnosis and treatment. Methods 48 cases of residual cholecyst with gallstones were reviewed retrospectively and the clinical records were analysed. Results All of 48 case were showed a difficult procedures during first cholecystectomy. The clinical manifestation along with 48 patients were similar to that of non-cholecystectomy ones. There were 95% of cases （46/48） being diagnosed pre-operatively. All of 48 patients were cured by a belly-open residual-cholecystectomy and no complication was found during 1 to 7 years following up stage. Conclusion The main reason caused residual cholecyct with gallstones is mis-identification of cholecyst＇s outflow tract. The main symtoms and signs of residual cholecyst with gallstones is similar to that of intact cholecyst with gallstones. One of important thing in the diagnosis is to think of the disease possibility. Inorder to prevent the residual cholecyst with gallstones the careful identification to cholecyst outflow tract may be further emphasized. Re-operation may be a preferential choice for treating this disease.