胆道再手术原因和对策  

Causes and countermeasures for reoperation in patients with biliary tract diseases

作　　者：戴德坚[1] 陆才德[2] 武金才[3] 孟化[1] 

机构地区：[1]浙江大学医学院附属第二医院普外科,杭州市310009 [2]宁波大学附属李惠利医院普外科 [3]衢州市人民医院肝胆外科

出　　处：《中华肝胆外科杂志》2005年第10期692-694,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆道再手术原因及对策。方法回顾分析我院1999年1月至2002年12月间共行了胆道手术2 881例,其中因各种原因行胆道再手术260例;并对其首次手术方式,再次手术方式和再次手术原因进行了详细分析。结果109例行胆总管切开取石,其中33例同时行肝叶切除;32例行胆总管空肠Roux-Y吻合术;94例行胆道镜取石术;2例行胰十二指肠切除术;残余胆囊再切除1例;22例分别行引流、止血或修补术。再手术原因早期主要以胆漏(7.3%)、腹腔内出血(1.2%)为主。晚期主要以结石残留或复发(76.9%),胆管良性狭窄(11.5%)为主。结论胆道再手术主要原因是处理胆道手术并发症。为降低胆道再手术率应强调术前全面分析诊断、术中审慎操作,并结合胆道镜、B超及胆道造影等检查行根治性手术,术后加强抗感染预防炎性狭窄。Objective To investigate the causes and countermeasures for reoperation in patients with biliary tract diseases. Methods The approaches of the first operation and reoperation and causes for the reoperation were analyzed for 260 patients with biliary tract diseases receiving reoperation in our hospital from January 1999 to December 2002. Results Of the 260 patients, 109 underwent chole- docholithotomy （33 of them received the operation in combination with lobectomy）, 32 Roux-en-Y choledochojejunostomy, 94 choledochoscopy, 2 pancreaticoduodenostomy, 1 re-excision of the residual cholecyst and 22 drainage, hemostasis or biliary tract repair, respectively. Bile leakage （7.3%） and celiac bleeding （1.2%） were responsible for early reoperation while recurrent or residual duct stones （76.9%） and bile duct stricture （11.5%） for the late reoperation. Conclusions The main purpose of reoperation in the patients with biliary tract diseases is to deal with different surgical complications. To decrease the rate of reoperation, it should be emphasized to confirm diagnosis preoperatively, employ choledochoscopy and B-mode ultrasonography, operate carefully and precisely, perform radical resection and pay close attention to fighting against infection to prevent inflammatory stenosis postoperatively.

关 键 词：再手术 胆道 胆道手术并发症 再手术原因 胆总管空肠Roux-Y吻合术 胰十二指肠切除术 胆道镜取石术 胆总管切开取石 胆道再手术 胆管良性狭窄 

分 类 号：R657.4[医药卫生—外科学]