Vater壶腹结石嵌顿的术中处理

Operative Management for Refractory Choledocholithiasis Incarcerated in Vater Ampulla

目的探讨Vater壶腹结石嵌顿的术中处理技巧。方法回顾性分析2003年8月。2006年12月共35例此类病人的临床资料。30例经胆总管下段切开取石，25J行经十二指肠Oddi括约肌切开取石，3例行胆道镜下微爆破碎石仪碎石术。结果所有手术均成功，无一例病人出现大出血、胆漏、肠漏等严重的并发症。平均随访18个月，均无腹痛及胆总管结石复发。结论Vater壶腹嵌顿结石的处理应根据病人病情及医疗条件抉择，在剖腹术中采取经胆总管下段切开取石较为简便和安全。

Objective To study the surgical technique of refractory choledocholithiasis incarcerated in Vater ampulla. Method Clinical data of 35 cases with refractory choledocholithiasis incarcerated in Vater ampulla admitted from Aug. 2003 to Dec. 2006 were analyzed retrospectively. Among them, 30 patients underwent choledocholithotomy, 2 underwent Oddi sphincterotomy, and the other 3 underwent micro-explosion litho-tripsy through extra-thin choledochoscope. Results All the operations succeeded without severe complication such as hemorrhage, biliary leakage or intestinal fistula. In the average 18 months follow-up, no abdominal pain and choledocholithiasis recurrence occurred. Conclusion Different surgical procedures should be selected for refractory choledocholithiasis incarcerated in Vater ampulla according to different ill status and medical conditions. Choledocholithotomy is a simple and safe method for open surgery.