腹腔镜胆囊切除术前后B超检查阴性的胆总管结石诊断和处理

目的探讨腹腔镜胆囊切除术(LC)前后B超检查阴性的胆总管结石的诊断与处理。方法对42例腹腔镜胆囊切除术前和9例LC术后患者怀疑有胆总管结石而B超检查阴性的患者用MRCP和，或ERCP作进一步检查。结果LC术前诊断为胆总管结石25例中24例经ERCP、EST术顺利取出胆总管结石，1例EST失败，改行开腹手术。LC术后5例患者均行EST术取出胆总管残余结石。术后并发症是一过性反应性胰腺炎5例，乳头出血1例，肺部感染1例，均经保守治疗，所有患者均痊愈出院。结论B超检查阴性的胆总管可能存在结石，MRCP是发现胆总管结石的最佳的无创诊断方法，ERCP和EST是确诊和取出胆总管结石的微创有效的治疗方法。

Diagnosis and treatment of choledocholith with negative results of ultrasonography before and after LC

Objective To research the diagnosis and treatment of choledocholith with negative results of ultrasonography before and after LC. Methods 51 cases suspected choledocholith with negative results of ultrasonography before(42) and after LC(9)were examined by MRCP and/or ERCP.Results Among them,30 cases with chodedocholith were found.29 cases were treated by ERCP and EST,1 cases was treated by operation.postoperative complications were transient reactive pancreatitis in 5 cases,duodenal papillary bleeding 1 case and pulmonary infection 1 case.All cases were cured to discharge from hopsital.Conclusion Common bile duct negative results with ultrasonography may present stones in it.MRCP is the best diagnostic method without trauma and ERCP plus EST are most effective method of diagnosis and treatment of choledocholith.