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首页> 外文期刊>Surgical Endoscopy >Retained gallbladder/cystic duct remnant calculi as a cause of postcholecystectomy pain.
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Retained gallbladder/cystic duct remnant calculi as a cause of postcholecystectomy pain.

机译：胆囊/胆囊管残余结石保留，是导致胆囊切除术后疼痛的原因。

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BACKGROUND: Pain following cholecystectomy can pose a diagnostic and therapeutic dilemma. We reviewed our experience with calculi retained in gallbladder and cystic duct remnants that present with recurrent biliary symptoms. METHODS: Over the last 6 years, seven patients were referred to us for the evaluation of recurrent biliary colic or jaundice. There were four men and three women ranging in age from 35 to 70 years. All seven had biliary pain similar to the symptoms that precede cholecystectomy; two of them also had also associated jaundice and one had pancreatitis. The time from cholecystectomy to onset of symptoms ranged from 14 months to 20 years (median, 8.5 Years). Four had undergone laparoscopic cholecystectomy and three had had an open cholecystectomy; none had an operative cholangiogram. RESULTS: Five of seven underwent diagnostic endoscopic retrograde cholangiography (ERC), which revealed obvious filling defects in the cystic duct or gallbladder remnant. The final patient was diagnosed by laparoscopic ultrasound after eight negative radiographic studies. Four patients underwent laparotomy and resection of a retained gallbladder and/or cystic duct. Two patients were treated with extracorporeal shock-wave lithotripsy (ESWL); one of them also required endoscopic biliary holmium laser lithotripsy. One patient underwent successful repeat laparoscopic cholecystectomy. There were no treatment-related complications. At a median follow-up of 11.5 months, all have achieved complete stone clearance and are asymptomatic. CONCLUSION: Retained gallbladder and cystic duct calculi can be a source of recurrent biliary pain, and a heightened suspicion may be required to make the diagnosis. This entity can be prevented by accurate identification of the gallbladder-cystic duct junction at cholecystectomy and by routine use of cholangiography. A variety of therapeutic options can be employed to obtain a successful outcome.
机译：背景：胆囊切除术后的疼痛可能会带来诊断和治疗上的困境。我们回顾了胆结石和胆囊管残余残留结石的经验，这些结石表现为胆道症状反复发作。方法：在过去的6年中，有7名患者被转介给我们，用于评估复发性胆绞痛或黄疸。有四名男子和三名妇女，年龄在35至70岁之间。所有七个患者的胆道疼痛均类似于胆囊切除术之前的症状。他们中的两个人也患有黄疸，一个人患有胰腺炎。从胆囊切除术到症状发作的时间范围为14个月至20年（中位数为8.5年）。其中四例接受了腹腔镜胆囊切除术，三例接受了开放性胆囊切除术。没有人进行过手术胆道造影。结果：七例中有五例接受了内镜逆行胆道造影（ERC）检查，发现其在胆囊管或胆囊残余物中存在明显的充盈缺损。在八项放射学阴性检查后，最后一名患者通过腹腔镜超声诊断。四名患者接受了剖腹术并切除了保留的胆囊和/或胆囊管。两名患者接受体外冲击波碎石术（ESWL）治疗;其中之一还需要内镜胆道激光碎石术。一名患者成功进行了重复腹腔镜胆囊切除术。没有与治疗有关的并发症。在11.5个月的中位随访中，所有患者均已完成结石清除并且无症状。结论：保留的胆囊和胆囊结石可能是复发性胆道疼痛的来源，可能需要进一步怀疑以进行诊断。可以通过在胆囊切除术中准确识别胆囊-胆囊管交界处以及常规使用胆管造影术来预防这种情况。可以采用多种治疗选择来获得成功的结果。

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