目的总结1例非肝移植胆管铸型患者的诊治过程。 方法对1例非肝移植胆管铸型患者的临床资料、辅助检查资料及治疗效果进行分析，并进行文献复习。 结果1例非肝移植胆管铸型患者经生化检查、胆胰管水成像（MRCP）、上腹部CT等检查诊断为胆囊结石伴胆囊炎、胆总管结石伴低位胆管梗阻。采取开腹胆道探查、胆道镜检查取石、胆囊切除、T管引流手术治疗。术中见胆囊缩小，与周围大网膜膜性粘连，肝十二指肠韧带水肿，胆总管扩张呈充盈状态。胆道镜下见肝内外胆管轻度扩张，肝外胆管壁炎性水肿较重，大量纤维素附着；胆总管末端通畅，可见胰管开口，进而诊断为胆胰合流异常。以胆道镜从胆总管内取出1枚结石，约2.0 cm×1.5 cm×1.0 cm大，质硬，表面光滑；另取出1枚胆管铸型，约3.5 cm×0.3 cm×0.3 cm大，质脆易碎，表面粗糙。该患者的手术顺利，切除胆囊术后病理学检查示慢性胆囊炎改变。术后恢复良好，未出现胆汁漏、出血等并发症。术后随访1年，复查上腹部CT提示无结石复发，肝功能各项指标均正常。 结论非肝移植胆管铸型较少见，胆胰合流异常是非肝移植胆管铸型和胆管结石形成的原因之一。胆道镜是清除胆管铸型和观察胆管内结构的重要工具。
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.