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Giant Choledochal Calculosis: Surgical Treatment

机译:巨型胆总管结石:外科治疗

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Context:Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP), this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm), which is rare in surgical practice and our treatment with open surgery.Case Report:The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP) had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD) was performed. The patient was discharged without any complications on postoperative 8th day.Conclusion:Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions.
机译:背景:胆结石病是最常见的手术病理之一。在某些情况下可能会发生胆石症,需要手术干预。尽管有相对无创的手术,例如内窥镜逆行胰胆管造影术(ERCP),但这种技术通常在结石大于10 mm的患者中不成功。在本例中,我们旨在报告一块巨大的胆总管结石(15厘米×4.5厘米),这在外科手术和开放手术治疗中很少见。病例报告:该患者是一名59岁的女性。磁共振胰胆管造影(MRCP)显示了胆囊积水过多的CBD和110 mm×41 mm的结石。在手术中,观察到过度扩张的CBD,在进行了胆总管切开术和非常大的结石后,CBD完全充满。进行胆管切开术切口,并进行带有胆总管十二指肠吻合术(CD)的T管胆管切开术。术后第8天出院,无任何并发症。结论:良性胆结石病是一个多因素过程,其危险因素包括肥胖,溶血性疾病,糖尿病和妊娠。胆总管结石的危险因素与胆结石疾病的危险因素相似。 MRCP是检测胆总管结石的一种非侵入性技术。 CBD宝石的金标准干预措施是ERCP。 CBD中的石头可能会达到非常大的尺寸而不会引起严重的症状。最常见的症状是黄疸。在术前放射学检查期间,巨大的结石可能会干扰恶性肿瘤。外科医生在诊断时应遵循常规算法,并且在早期阶段必须牢记开放手术,而不必过于坚持内镜干预。

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