Shore J M
Calif Med. 1971 May;114(5):1-6.
Residual calculi following cholecystectomy may be expected in approximately seven percent of cases. The vast majority of these are overlooked during operation; truly re-formed stones are rare. Calculi are missed during cholecystectomy because of failure to explore the common bile duct. This is due to (1) the presence of silent choledochal stones, and (2) reliance on negative cystic duct cholangiograms in the presence of indications for common duct exploration. Overlooking of silent stones during cholecystectomy may be prevented by routine operative cholangiography. Ideally, false-negative cystic duct cholangiograms should be eliminated by the use of fluoroscopic cholangiography. Retained calculi following duct exploration may be prevented by (a) routine biliary endoscopy and (b) completion fluoroscopic cholangiography.Re-formation of ductal calculi can probably be prevented by appropriate biliary drainage procedures performed during the initial choledochotomy. Selection of patients for primary biliary decompression remains an experimental problem.
胆囊切除术后残留结石的发生率约为7%。其中绝大多数结石是在手术中被遗漏的，真正重新形成的结石很少见。结石在胆囊切除术中被遗漏是因为未探查胆总管。这是由于：（1）存在无症状的胆总管结石；（2）在有胆总管探查指征的情况下依赖胆囊管胆管造影阴性结果。通过常规手术胆管造影可预防胆囊切除术中遗漏无症状结石。理想情况下，应通过使用荧光透视胆管造影消除假阴性胆囊管胆管造影结果。通过（a）常规胆道内镜检查和（b）完成荧光透视胆管造影可预防胆管探查后残留结石。通过在初次胆总管切开术中进行适当的胆道引流程序，可能预防胆管结石的重新形成。选择患者进行原发性胆道减压仍然是一个有待实验解决的问题。
