Selvaggi F, Di Bartolomeo N, De Iuliis I, Del Ciotto N, Innocenti P
Surgical Sciences Department , G. d'annunzio, University, Chieti, Italy.
G Chir. 2011 Jun-Jul;32(6-7):335-7.
Inadequate calculi removal, bile stasis, inflammation and strictures are causes of postcholecystectomy biliary syndrome. A cystic duct remnant is defined as a residual duct greater than 1 cm; it may predispose to chronic postcholecystectomy symptoms.
We describe a case of a 33-years-old woman with recurrent epigastric pain radiating to right back. In the past medical history, an uncomplicated cholecystectomy was reported 11 years earlier. Imaging demonstrated a 2 cm impacted calculus within a cystic duct remnant, mimicking a so-called reformed gallbladder. At the magnetic resonance imaging the biliary tract was regular without dilatation. The patient was scheduled to laparoscopic exploration. Intraoperatively, the cystic duct stump containing the impacted calculus was easily found and meticulously dissected from extrahepatic bile structures.
In our experience the laparoscopic removal was safely performed with complete cystic duct remnant excision and definitive cure of chronic painful symptoms. Therefore we think that, in selected cases, the reoperation is feasible by means of mininasive surgical procedures.
结石清除不彻底、胆汁淤积、炎症和狭窄是胆囊切除术后胆道综合征的病因。胆囊管残余被定义为长度大于1厘米的残留管道；它可能导致胆囊切除术后出现慢性症状。
我们描述了一例33岁女性病例，该患者反复出现上腹部疼痛并向右背部放射。既往病史显示，11年前曾进行过一次无并发症的胆囊切除术。影像学检查显示胆囊管残余内有一枚2厘米的嵌顿结石，类似所谓的“再生胆囊”。磁共振成像显示胆道正常，无扩张。患者计划接受腹腔镜探查。术中，很容易找到含有嵌顿结石的胆囊管残端，并从肝外胆管结构中仔细分离出来。
根据我们的经验，通过腹腔镜切除可安全地完全切除胆囊管残余，并彻底治愈慢性疼痛症状。因此，我们认为，在某些特定病例中，通过微创手术进行再次手术是可行的。
