腹腔镜胆囊切除术后胆总管残留结石的防治

Prevention of residual common bile duct stones after laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic choleystectomy,LC)后胆总管残留结石的原因和预防措施。方法我院2003年1月至2008年6月无胆道镜前发生LC术后胆总管残留结石11例,2008年7月至2011年1月有胆道镜后可疑合并胆总管结石10例,比较分析二者术前诊断及术中处理方法。结果无胆道镜前发生的11例经LC并胆总管切开取石术或开腹胆总管探查取石治愈;有胆道镜后10例经过胆道镜检查和选择性胆道造影处理,术后均未发生胆总管残石。结论 LC术后胆总管残留结石应重视,术前积极检查,术中正确处理可以预防。

Objective To evaluate the causes and preventive measures for residual common bile duct stones after laparoscopic cholecystectomy（LC）.Methods Preoperative diagnosis and intraoperative treatment were analyzed for 11 cases of residual common bile duct stones after LC without choledochoscope from January 2003 to June 2008 and 10 suspected cases of residual common bile duct stones after LC with choledochoscope from July 2008 to January 2011.Results The 11 cases without choledochoscope were cured by laparoscopic cholecystectomy and laparoscopic common bile duct exploration or open common bile duct exploration.After choledochoscope was used with intraoperative cholangiography,10 patients were cured without residual common bile duct stones.Conclusions We should pay attention to residual common bile duct stones after laparoscopic cholecystectomy.Complications can be prevented by positive examination before operation and correct judgment during treatment.