飞行人员胆囊结石继发胆总管结石1例并文献复习

Treatment of one pilot with choledocholithiasis secondary to cholecystolithiasis:a case report and literature review

目的通过1例军事飞行人员胆囊结石继发胆总管结石诊治过程及经验教训,结合文献复习为该病在飞行人员中的诊治及航空医学鉴定提供参考。方法回顾性分析该患者病史中临床表现、检验检查、诊治思路及结果、鉴定结论,并复习国内外相关文献,对飞行人员胆囊结石继发胆总管结石的诊治及航空医学鉴定提出建议。结果该患者因胆囊结石诱发急性胆囊炎、胆绞痛,病情反复发作,继发胆总管结石、胆管炎。因拒绝切除胆囊,行腹腔镜下保胆取石、胆总管切开取石一期缝合术,术后3年因胆囊结石、胆总管结石复发,再次行腹腔镜下胆囊切除、胆总管探查取石术(laparoscopic commonbileductexploration,LCBDE),术中发现胆囊三角粘连严重合并胆管狭窄,遂中转开腹行胆囊切除术、胆总管探查取石术、胆总管整形术、T管引流术,术后带T管6个月,经T管造影及胆道镜检查无胆管狭窄及结石残留,乳头肌功能正常,拔除T管,随访1年无不适,经本人申请及航空病检查鉴定结论:飞行合格。结论飞行人员罹患胆囊结石诱发急性胆囊炎或继发胆总管结石者应行胆囊切除、同时行胆总管探查取石,手术方式首选腹腔镜下完成,尽量避免开腹手术以减小创伤,造成不必要的停飞。

Objective To find out more about the diagnosis,treatment and aviation medical evaluation of choledocholithiasis secondary to cholecystolithiasis by analyzing the experience and lessons learned from treating one case of military pilot and via literature review.Methods This case was retrospectively analyzed in terms of clinical manifestations,detection and examination,diagnostic and therapeutic approaches,and aviation medical evaluation conclusions.Related literature at home and abroad was reviewed to gain insights into choledocholithiasis secondary to cholecystolithiasis among military pilots.Results The patient who had acute cholecystitis and biliary colic caused by cholecystolithiasis received conventional treatment because of his refusal to be operated on.When secondary choledocholithiasis and cholangitis occurred that were caused by the recurrence of the disease,laparoscopic choledocholithotomy and primary suture with gallbladder preservation were performed.Three years later,with the recurrence of choledocholithiasis and cholecystolithiasis,laparoscopic cholecystectomy,common bile duct exploration and bile stone removal were performed.During the operation,severe adhesion in Calot's triangle complicated with bile duct stricture was found and laparotomy was performed,followed by cholecystectomy,common bile duct exploration and bile stone removal,choledochoplasty,and T-tube drainage.With the T tube for 6 months,radiography through the T tube and biliary endoscopy examination were performed.No bile duct stricture or residual stones were found and the sphincter of Oddi was in good function.The T tube was removed and the patient had no specific discomfort during one-year follow-up.The patient returned to flight after aviation medical evaluation.Conclusion Pilots with cholecystolithiasis-induced recurrent acute cholecystitis or with secondary choledocholithiasis are advised to receive cholecystectomy,common bile duct exploration and bile stone removal.Laparoscopic operation is preferred.Open surgery should be avoided by each means available to reduce trauma and the consequent grounding.