CAJ | 학술논문

目的：探讨腹腔镜下经残余胆囊管胆道探查取石或经胆总管切开探查取石术联合残余胆囊切除治疗残余胆囊结石合并胆总管结石的安全性和可行性。方法2008年2月～2014年6月我院对15例残余胆囊结石合并胆总管结石（开腹胆囊切除术后7例，腹腔镜胆囊切除术后8例）采用腹腔镜下经残余胆囊管胆道探查取石或经胆总管切开探查取石联合腹腔镜残余胆囊切除。结果14例（93．3％）完成腹腔镜下残余胆囊切除和胆总管探查取石术，其中7例经残余胆囊管胆道探查取石，7例经胆总管切开探查取石；1例（6．7％）因残余胆囊三角炎症严重中转开腹。结石取净率100％。1例术后T管脱出但未造成严重后果。15例随访6～70个月（中位数20个月），未发生术前症状复发、胆总管结石复发或胆总管狭窄等并发症。结论腹腔镜下经残余胆囊管胆道探查取石或经胆总管切开探查取石联合残余胆囊切除是治疗残余胆囊结石合并胆总管结石安全和可行的方法。
목적：탐토복강경하경잔여담낭관담도탐사취석혹경담총관절개탐사취석술연합잔여담낭절제치료잔여담낭결석합병담총관결석적안전성화가행성。방법2008년2월～2014년6월아원대15례잔여담낭결석합병담총관결석（개복담낭절제술후7례，복강경담낭절제술후8례）채용복강경하경잔여담낭관담도탐사취석혹경담총관절개탐사취석연합복강경잔여담낭절제。결과14례（93．3％）완성복강경하잔여담낭절제화담총관탐사취석술，기중7례경잔여담낭관담도탐사취석，7례경담총관절개탐사취석；1례（6．7％）인잔여담낭삼각염증엄중중전개복。결석취정솔100％。1례술후T관탈출단미조성엄중후과。15례수방6～70개월（중위수20개월），미발생술전증상복발、담총관결석복발혹담총관협착등병발증。결론복강경하경잔여담낭관담도탐사취석혹경담총관절개탐사취석연합잔여담낭절제시치료잔여담낭결석합병담총관결석안전화가행적방법。
Objective To assess the feasibility and safety of laparoscopic transcystic common bile duct exploration ( LTCBDE) or choledochotomy combined with laparoscopic remnant cholecystectomy for the treatment of gallbladder remnant calculi and choledocholithiasis . Methods From February 2008 to June 2014, we performed LTCBDE or laparoscopic choledochotomy ( LCD) combined with laparoscopic remnant cholecystectomy in 15 cases of gallbladder remnant calculus and choledocholithiasis .All the patients had received open ( 7 cases ) or laparoscopic ( 8 cases ) cholecystectomy because of cholelithiasis . Results Fourteen patients (93.3%) underwent successful laparoscopic remnant cholecystectomy and common bile duct exploration ,including 7 cases of LTCBDE and 7 cases of LCD.A conversion to open surgery was required in 1 patient (6.7%) due to severe inflammation in the Calot’s triangle.The clearance rate of common bile duct stones was 100%.One patient experienced postoperative T-tube extrusion, without severe adverse outcomes .During follow-up reviews for 6 -70 months ( median, 20 months ) in the 15 patients, no complications, such as recurrence of symptoms, common bile duct stones, or common bile duct stricture, recurred. Conclusion Laparoscopic transcystic common bile duct exploration or choledochotomy combined with laparoscopic remnant cholecystectomy is a safe and feasible option for gallbladder remnant calculus complicated with choledocholithiasis .