非扩张性胆总管继发结石20例临床分析

Non-dilated extrahepatic bile duct calculus in 20 cases

目的探讨非扩张性胆总管继发结石的临床特点和漏诊原因。方法回顾分析该院2005-2009年20例非扩张性胆总管继发结石的病例资料。结果 2例患者于术前诊断,其中1例患者行胆总管切开取石术,术后出现胆道狭窄而行胆肠吻合术,1例患者行经胆囊管纤维胆道镜取石术。18例患者行腹腔镜胆囊切除术,术后出现腹痛、黄疸而明确诊断,其中6例患者行十二指肠镜乳头括约肌切开术（EST）后治愈,其余患者行利胆排石、解痉等保守治疗后治愈。结论非扩张性胆总管继发结石漏诊原因是多方面的;非扩张性胆总管继发结石治疗应首先行利胆排石、解痉等保守治疗,再遵循EST取石、再经胆囊管纤维胆道镜取石,尽量避免胆总管切开取石。

【Objective】To investigate the clinical characteristic and cause of non-dilated extrahepatic bile duct calculus.【Methods】Data of 20 patients with non-dilated extrahepatic bile duct calculus from 2005 to 2008 were analyzed retrospectively.【Results】Only 2 patients were found non-dilated extrahepatic bile duct calculus before operation.18 patients were found non-dilated extrahepatic bile duct calculus after laparoscopic cholecystectomy（LC）.One patient who underwent open common bile duct exploration.OCBE had bile duct stenosis.One patient was performed cholecystectomy and transcystic common bile duct exploration with choledochoscope（TC-CBDE）.6 patients were performed with endoscopic sphincterotomy（EST）.【Conclusion】Many causes lead to the erroneous diagnosis of non-dilated extrahepatic bile duct calculus.Conservative treatment is the fist choice for the patients with non-dilated extrahepatic bile duct calculus after LC.If it failed,the appropriate procedure for the management of non-dilated extrahepatic bile duct calculus is EST,and then TC-CBDE,avoiding OCBE.