择期腹腔镜胆囊切除术中胆囊管结石29例报告

Cystic Duct Lithiasis During Selective Laparoscopic Cholecystectomy:Clinical Study of 29 Cases

目的探讨择期腹腔镜胆囊切除术中胆囊管结石（cystic duct lithiasis,CDL）的发生率及处理方法。方法回顾性分析我科2012年6月～2013年12月336例择期LC中29例CDL的临床资料,对CDL的临床表现、诊断方法、处理方式进行分析。结果隐匿性胆囊管结石16例,梗阻性胆囊管结石12例,Mirizzi综合征1例;所有结石均取出。存在胆总答结石8例（27.6%）。29例术后随访平均10个月（6～20个月）,无胆道狭窄和结石残留等并发症。结论 CDL在胆囊结石患者中并不少见,术前诊断困难,隐匿性结石比率高。腹腔镜胆囊切除术中应掌握正确的处理办法,对胆囊管全程游离和系统探查,从根部离断胆囊管,以免术后CDL残留。

Objective To study the incidence and treatment of cystic duct lithiasis（ CDL） during selective laparoscopic cholecystectomy. Methods A total of 29 cases of CDL among 336 cases of selective laparoscopic cholecystectomy from June 2012 to December 2013 were retrospectively analyzed. The clinical manifestation,diagnostic methods,and operative strategies were analyzed.Results Among the 29 cases,there were 16 cases of occult CDL,12 obstructive CDL,and 1 case of Mirizzi syndrome. All the stones were removed. Common bile duct stone（ CBDS） occurred in 8 cases（ 27. 6%）. Postoperative follow-ups for 6- 20 months（ mean,10 months） in the 29 cases found no biliary stenosis or residual stones. Conclusion Cystic duct lithiasis is found frequently during selective laparoscopic cholecystectomy. Preoperative diagnosis is difficult,leading to a high rate of occult CDL. The exploration for CDL and complete excision of the cystic duct should be routinely performed during laparoscopic cholecystectomy.