CAJ | 학술논문

目的：总结分析胆囊管结石漏诊的原因及术后胆管结石的中西医结合预防。方法回顾性分析我院2008年1月—2013年12月166例术前及术中诊断为胆囊管结石患者的临床资料，对患者的一般资料，手术情况，术后并发症及术后中西药结合预防胆管发生结石的情况进行统计学分析。结果166例胆囊管结石患者术前全部行腹部B超检查，确诊胆囊管结石76例（阳性率46%）。全部患者均顺利完成手术，无围手术期死亡患者。术后胆囊管残余结石3例，腹腔出血1例，胆漏1例，右肝管损伤1例，戳孔感染2例。术后随访1-5年，随访期间，13例患者术后胆管再发结石，中西医联合治疗组1例（1.8%），单纯西药组4例（7%），不能坚持用药组8例（16%），行ERCP治疗9例，开腹手术胆道探查取石4例。结论胆囊管结石术前确诊困难、确诊率低，容易漏诊，术中如果没有及时发现和妥善处理，容易导致胆囊管结石残留，给患者带来痛苦和经济负担，中西医结合可以减少胆管结石的发生。
목적：총결분석담낭관결석루진적원인급술후담관결석적중서의결합예방。방법회고성분석아원2008년1월—2013년12월166례술전급술중진단위담낭관결석환자적림상자료，대환자적일반자료，수술정황，술후병발증급술후중서약결합예방담관발생결석적정황진행통계학분석。결과166례담낭관결석환자술전전부행복부B초검사，학진담낭관결석76례（양성솔46%）。전부환자균순리완성수술，무위수술기사망환자。술후담낭관잔여결석3례，복강출혈1례，담루1례，우간관손상1례，착공감염2례。술후수방1-5년，수방기간，13례환자술후담관재발결석，중서의연합치료조1례（1.8%），단순서약조4례（7%），불능견지용약조8례（16%），행ERCP치료9례，개복수술담도탐사취석4례。결론담낭관결석술전학진곤난、학진솔저，용역루진，술중여과몰유급시발현화타선처리，용역도치담낭관결석잔류，급환자대래통고화경제부담，중서의결합가이감소담관결석적발생。
Objective To summarize and analyze the reason of preoperative misdiagnosis of calculus in cystic duct, and explore the pre-vention and treatment of calculus in cystic duct with integrated medicine. Methods We retrospectively analyzed the clinical data of 166 calculus in cystic duct patients in PLA General Hospital between January 2008 and December 2013. The general data, operation data, postoperative complications and prevention and treatment with integrated medicine information of the patients were statistical analyzed. Results All of the 166 patients underwent abdominal ultrasound examination before operation, and 76 cases were diagnosed of cystic duct stones ( positive rate was 46%) . All patients were successfully completed the operation, and no patient dead during the perioperation. Three patients had remnant calculus in cystic duct after the operation, one case of abdominal hemorrhage, one case of bile leakage, one case of right hepatic duct injury, and two cases of incision infection. During the 1-5 years of follow‐up, 13 patients had recurrence of cal-culus in cystic duct. There were one (1.8%) case in the integrated medicine group, 4 (7%) cases in the only western medicine group, and 8 (16%) cases in cannot adhere to medication group. Nine patients underwent ERCP treatment and four patients underwent abdomi-nal operation. Conclusion The calculus in cystic duct is difficult to be diagnosed before operation and the diagnosis rate is low. If it is misdiagnosis, it will easy to cause the calculus remain in the cystic duct, and bring pain and economic burden to patients. The integrated medicine can reduce the occurrence of bile duct stone.