腹腔镜胆囊切除术后综合征32例临床分析

Clinical Analysis of 32 Cases with Laparoscopic Postcholecystectomy Syndrome

目的:探讨腹腔镜胆囊切除术后综合征(LPCS)的病因、诊治及预防措施。方法:回顾性分析32例LPCS患者的临床资料。结果:17例为胆系原因,包括腹腔镜胆囊切除术后胆管残留结石、胆管损伤性狭窄、胆囊管残留结石或过长、乳头良性狭窄、胆管功能紊乱、胆管肿瘤等,其中2例为胆管功能紊乱;12例为胃部疾病原因,包括胆囊结石并胆汁反流性胃炎、萎缩性胃炎、胃十二指肠溃疡等。对17例胆系原因病例根据不同情况有5例行相应手术治疗,另12例保守治疗。随访32例患者:21例治愈,7例好转,4例无效。结论:术前完善相关检查、注意其他并发症、术中规范操作可有效预防LPCS。

Objective：To discuss the pathogeny,diagnosis and treatment,and prophylactic measures of Laparoscopic postcholecystectomy syndrome（LPCS）.Methods：The clinical data of 32 patients with LPCS were analyzed.Results：17cases were due to the reasons of biliary system,including bile duct residual stones after laparoscopic cholecystectomy,the bile duct stenosis,gallbladder tube residual stones or a long residual cystic canal,nipple benign stricture,Oddi sphincter dysfunction,bile duct tumor etc;2 cases were due to bile duct dysfunction,12 cases were due to gastric disease reasons,including gallbladder stone merger reflux gastritis,atrophic gastritis,gasteroduodenal ulcer,and so on;In 17cases whose etiological factor were due to the reasons of biliary system,and 5 cases were treated with different surgeries accorded to different etiological factors,another 12 cases were treated with conservative treatment.Total 32 patients were followed up,and 21 cases cured,and 7 cases relieved,4 cases no effective.Conclusion：Careful preoperative examination and diagnosis,normalized operation can effectively prevent LPCS.