腹腔镜胆囊切除术后综合征的原因分析

从１９９３年至１９９７年我们对经腹腔镜胆囊切除手术４２１例病人进行跟踪随访分析腹腔镜胆囊切除术后仍有症状反复发作的原因及发生率，发生率是１６％，这个百分率与传统剖腹胆囊切除基本相同，腹腔镜胆发除术前、术中遗漏与胆囊无关疾病的诊断引起症状数量较同，良性和恶性，这个能反映出术前详细检查的重要性，与剖腹术比较腹腔手术时检查腔内病变是困难的，而有胆囊切除后胆道运动紊乱引起综合征经药物治疗后可得到改善。     

腹腔镜胆囊大部切除术后并发胆囊管残留综合征的原因和防治

目的:探讨腹腔镜胆囊大部切除术后并发胆囊管残留综合征的原因和防治。方法:回顾分析231例胆囊切除手术的临床资料。结果:205例传统胆囊切除术(open cholecystectomy,OC)术后1例并发胆囊管残留综合征(cholecystic duct rem-nant syndrome,CDRS),占0.49%;26例腹腔镜胆囊大部切除术术后2例并发CDRS,占7.31%。腹腔镜胆囊大部切除术后CDRS发生率高于OC(P=0.03)。结论:严格把握腹腔镜胆囊大部切除术的适应证和规范操作是预防CDRS的关键。     

胆囊切除术后综合征

临床有部分患者胆囊切除术后出现或重新出现与术前类似的症状，如恶心、呕吐、腹胀不适、右上腹疼痛等称为胆囊切除术后综合征（post cholecystectomy syndrome，PCS）。引起PCS的原因分为两大类，一是胆胆管相关因素，如胆管结石、胆囊管残端过长、再生胆囊、胆道良性狭窄、胆道感染等；二是胆道外病因，包括肠道易激惹综合征、消化性溃疡、肝脏疾病、腹腔内粘连、冠状动脉疾病、膈疝等。临床诊断包括：B超、静脉胆道造影、胃肠道钡餐检查、CT、ERCP、MRCP、MRI等，一般都可找到确切的病因。通过药物、内镜或手术治疗能取得满意效果。有的病人也可由精神因素引起，需进行精神病因检查及治疗。     

胆囊切除术后综合征

临床有部分患者胆囊切除术后出现或重新出现与术前类似的症状,如恶心、呕吐、腹胀不适、右上腹疼痛等称为胆囊切除术后综合征(post cholecystectomy syndrome,PCS)。引起PCS的原因分为两大类,一是胆胆管相关因素,如胆管结石、胆囊管残端过长、再生胆囊、胆道良性狭窄、胆道感染等;二是胆道外病因,包括肠道易激惹综合征、消化性溃疡、肝脏疾病、腹腔内粘连、冠状动脉疾病、膈疝等。临床诊断包括:B超、静脉胆道造影、胃肠道钡餐检查、CT、ERCP、MRCP、MRI等,一般都可找到确切的病因。通过药物、内镜或手术治疗能取得满意效果。有的病人也可由精神因素引起,需进行精神病因检查及治疗。     

胆囊切除术后综合征与胆囊管残留结石

胆囊切除术后患者原有症状仍然存在或再次出现上腹部不适、隐痛、向右肩部及背部放射、纳差、厌油等临床症状时称为胆囊切除术后综合征。目前国内外尚缺乏有关胆囊切除术后综合征的系统资料 ,其发病率较难估计。胆囊切除术后综合征发作时间长短不等 ,多数学者认为其多发生于术后 1.5～ 6年 ,但亦有学者认为术后各个时期均可发生。其发病原因尚未完全明了 ,多数学者认为与残留胆囊管过长或胆囊管内残留结石有关 ,亦有少数学者把胆囊切除术后由胆道残余结石、十二指肠乳头炎及胆总管下段狭窄等所致的不明原因的右上腹隐痛、不适统称为胆囊切除…     

腹腔镜胆囊切除术后胆囊管残留综合征

由于腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的广泛开展及其手术适应证的逐步扩大，随之而来的LC术中胆囊管残留问题摆在面前：术中胆囊管是否应保留较长以策安全？何谓胆囊管残留过长？何为胆囊管残留综合征（cholecystie duct remnant syndrome，CDRS）CDRS与胆囊切除术后综合征（postcholecystectomy syndrome，PS）有何关联？如何诊治与预防CDRS？现结合临床实践及相关文献讨论如下。     

胆囊切除术后综合征116例ERCP分析

目的探讨胆囊切除术后综合征的病因。方法回顾性总结分析2000年1月至2004年12月间临床诊断为胆囊切除术后综合征的116例ERCP资料。结果本组116例胆管显影率100％,胰管显影97例（83．62％）。原因为胆总管结石56例（48．28％）,十二指肠憩室、憩室内乳头19例（16．34％）,胆囊管残留过长、胆囊管结石15例（12．93％）,胆总管末端良性狭窄13例（11．20）,Oddis括约肌运动功能障碍4例（3．45％）,十二指肠乳头肿瘤3例（2．59％）,胆管损伤狭窄2例（1．73％）,硬化性胆管炎1例（0．86％）,胆管癌1例（0．86％）,残留胆囊伴结石1例（0．86％）,慢性胰腺炎伴胰管结石1例（0．86％）。结论胆囊切除术后综合征的原因以胆总管结石、十二指肠憩室、憩室内乳头、胆囊管残留过长、胆囊管结石、胆总管末端良性狭窄、Oddis括约肌运动功能障碍多见。胆囊切除术后术前症状不缓解或术后又复出现症状,不能拘于胆囊切除术后综合征的诊断,而是应积极寻找病因,以求得到合理治疗。     

胆囊切除术后综合征相关危险因素分析

[摘要]目的探讨胆囊切除术后综合征发生的相关危险因素。方法回顾性分析我院2006年1月-2011年1月治疗的542例行胆囊切除术患者的临床资料,分别对可能与胆囊切除术后综合征发生相关的因素进行分析,采用单因素与多因素分析筛选出相关因素。结果542例患者中,142例发生胆囊切除术后综合征。单因素分析结果显示性别（P=0．026）、胆囊管残留过长（P=0．022）、Oddi括约肌狭窄（P=0．002）与胆囊切除术后综合征发生相关;多因素分析显示Oddi括约肌狭窄（RR=11．563,P=0．017）为胆囊切除术后综合征发生的独立危险因素。结论Oddi括约肌狭窄为胆囊切除术后综合征发生的独立危险因素。     

胆囊切除术后综合征临床相关因素分析与预防

目的探讨胆囊切除术后综合征(PCS)预防与临床因素的关系。方法对我院2000年1月～2009年1月收治的68例高度怀疑胆囊切除术后综合征患者的资料进行回顾性分析。结果经过CT、B超、胃镜、肝功能等查因分析,证实30例为PCS,主要与急性炎症期手术、术式选择不当、术前病程过长等因素相关;其余38例患者虽然出现PCS相同的症状,但与胆囊切除无关,不能诊断为PCS。结论 PCS的发生与临床因素密切相关,术者严格规范操作可以减少PCS发生;查因可有助于正确判断PCS。     

胆囊切除术后问题

胆囊切除术是腹部外科最常见的手术之一。１９９４．１￣１９９５．１２,因胆囊结石行开腹胆囊切除术共９６２例,随诊７７９例（８１％）,其中１１７例（１５％）症状持续存在或者重新出现,以往统称谓“胆囊切除术后综合征”。通过仔细询问病史,选择恰当的诊断技术,这些症状可能符合某一诊断,治疗多可奏效。本文重点讨论胆囊切除术后问题的诊断和治疗。     

腹腔镜胆囊切除术后黄疸的分析及处理

目的 探讨腹腔镜胆囊切除术(LC)后黄疸的原因及治疗方法。方法 回顾性分析1995年10月～2001年12月施行LC术2047例中11例术后黄疸的原因及处理。结果 本组术后黄疸的发生率为0．54％(11／2047)，原因为胆漏(5／11，45．4％)、胆总管结石残留(2／11，18．2％)、急性胰腺炎(2／11，18．2％)、胆管炎性狭窄(1／11，9．1％)及急性肝功能损害(1／11，9．1％)。分别采用内镜下手术、开腹手术和保守治疗，取得满意疗效。结论 LC术后黄疸原因以胆漏及胆总管结石残留最为常见，及时对因处理可有效解除症状。     

The Role of Endoscopic Procedures in the Management of Postcholecystectomy and Posttraumatic Biliary Leak

Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool in the evaluation of the biliary system. It not only diagnoses the site of biliary leak following bile duct injury, but it also acts as a therapeutic modality to allow interventional pro-cedures such as sphincterotomy, nasobiliary drainage, or stent placement to be performed. The present study was carried out to evaluate the role of endoscopic management of biliary leak, following either liver trauma or cholecystectomy. Of a total 21 patients with bile leak following liver trauma and biliary surgery, 20 were managed by various endoscopic procedures. In the postcholecystectomy group, ERCP revealed a cystic duct leak in 9 patients and common bile duct injury in 6 patients. These complications were managed by sphincterotomy alone in 2 patients, by nasobiliary drainage alone in 4 patients, by sphincterotomy and nasobiliary drainage in 8 patients, and by sphincterotomy and stent placement in 1 patient. Posttraumatic biliary fistula was successfully managed by performing sphincterotomy followed by the placement of nasobiliary drainage in all of five patients who had suffered trauma injury. Received: August 2, 1999 / Accepted: July 25, 2000     

胆囊结石处理的临床决策：从适应证到术式选择的再探索

胆囊结石是胆道外科诊治的主要良性疾病,随着医学技术的发展和人们健康意识的提高,其检出率逐年提高,其中大部分为无症状或轻症胆囊结石。目前,胆囊结石的临床治疗主要为观察、保守治疗或行手术治疗（腹腔镜下胆囊切除术）等,但对于该类患者的临床处理尚存一定争议。主要是对于无症状或轻症胆囊结石,如何把握胆囊切除的适应证是学术界及临床一线争论的焦点。本文梳理了国内外相关文献,围绕胆囊结石的临床处理、胆囊切除适应证的把握等有关争议,从多个方面对其进行阐述。     

Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy

Background: Benign extrinsic obstruction of the hepatic duct, known as Mirizzi syndrome (MS), is an uncommon complication of longstanding cholelithiasis. Since laparoscopic cholecystectomy (LC) replaced the open approach, Mirizzi syndrome has regained the interest of biliary surgeons. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 13,023 patients undergoing LC between 1995 and 1999. This database was investigated with special regard to patients with Mirizzi syndrome. Results: There were 39 patients (14 men and 25 women; mean age, 61 years) with MS (incidence, 0.3%). Thirty-four patients had type 1 MS and five had type 2. A gallbladder carcinoma was found in four patients (incidence, 11%). In the type 1 group, 23 patients underwent cholecystectomy only, 10 patients had a bile duct exploration and T-tube insertion, and one patient had a Roux-en-Y reconstruction. In three patients with type 2, a hepaticojejunostomy was performed; two others underwent simple closure and drainage (via T-tube) of the biliary fistula. The conversion rate was 74% (24 of 34 patients) in the type 1 group and 100% (five of five patients) for type 2. The overall complication rate was 18%. There were no deaths. Conclusions: Although MS is rarely encountered during LC, it must be recognized intraoperatively. Conversion to an open approach is often needed, and prior to any surgical intervention, gallbladder cancer must be excluded. Presented at the combined meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the 8th World Congress of Endoscopic Surgery, New York, NY USA, 13–16 March 2002     

Postcholecystectomy syndrome after simple cholecystectomy

In a long-term follow-up, we were particularly interested in the incidence and cause of postoperative abdominal pain following simple cholecystectomy and in the incidence and etiology of reoperations of the biliary tract. For tat we analyzed 1539 patients who were operated by simple cholecystectomy between 1970 and 1979. Thereafter 875 (68.8%) were checked by us. We found 37.4% symptomatic patients, but in most cases no organic cause was detected. The major organic causes were scar problems and extrabiliary disorders; bilio-pancreatic disturbances were rare, but they needed a reintervention in most cases.     

老年人肘管综合征九例分析

目的探讨老年性肘管综合征的病因、诊断、鉴别诊断和手术疗效。方法对１９８９～１９９５年手术的９例６０岁以上肘管综合征的病因、症状、手术发现和远期随访结果进行分析研究。结果Ｘ线片显示：９例有Ｃ４，５，Ｃ５，６椎间隙狭窄、骨质增生，但部位均不在Ｃ８Ｔ１。３例曾因幼时外伤而致肘关节不能完全伸直或过伸；２例肘部尺神经滑脱；４例肘外翻畸形。９例就诊时间均在晚期，作尺神经前置术后平均随访２．５年，完全恢复７例，明显改善２例；手部肌力改善４例；爪形手畸形消失２例，无改善２例；但手内肌萎缩均无明显恢复。结论对老年性肘管综合征患者要强调和颈椎病的鉴别诊断，注意肘关节有无畸形，一旦确诊应及早手术，以提高治疗效果。