复发性肝内胆管结石再手术的疗效分析_临床医学论文.docVIP

复发性肝内胆管结石再手术的疗效分析_临床医学论文 复发性肝内胆管结石再手术的疗效分析_临床医学论文 【摘要】 目的：探讨不同术式治疗复发性肝内胆管结石的近远期效果。方法：回顾性分析76例复发性肝内胆管结石再手术患者的既往病史及手术方式、结石再发部位、治疗效果及随访结果等临床资料。以术后情况作为近期疗效分析的依据，以随访结果作为远期疗效分析的依据。结果：患者平均住院时间为10.4 d，术后并发症发生率为14.5%。院外随访8个月～8年，平均复发率为38.2%，联合式手术较单一式手术的复发率低（0.05）。结论：肝内胆管结石复发率高，应强调严格遵循“解除梗阻、去除病灶、通畅引流”的基本原则，重视首次手术。选择合适的手术方式是减少术后胆管结石复发、提高近远期疗效的关键。 【关键词】 胆管，肝内·结石·复发·再手术 　　【ABSTRACT】 Objective: To investigate the recent and forward effects of different operation patterns on recurrent calculus of intrahepatic duct. Methods: A analysis was made on previous history and operation patterns, distribution, effect and follow-up visit in 76 reoperation patients with recrudescent hepatolith between Jan, 2000 and Feb, 2008 in Affiliated Provincial Hospital of Anhui Medical University,retrospectively. The situation after operation was confirmed as the short-term curative effects and the follow-up results as long-term curative effects. Results: The average hospital stay was 10.4 days and the incidence rate of postoperative complications was 14.5%. The follow-up which lasted from 8 months to 8 years showed that the average recurernce rate was 38.2%. Besides, the rate of joint-type operation was lower than single-type operation（0.05）. Conclusion: Hepatolith is a disease with high recurrence rate. The principle such as ‘Relieving Obstruction, Removing Nidus and Flowing Smoothly’ is emphasized. We must pay attention to the first operation. The key of reducing the recrudescence and enhancing the recent and forward efficacy is choosing the appropriate type of operation. 　　【KEY WORDS】 Bile ducts, intrahepatic·Calculi·Recurrence·Reoperation 　　东亚地区是肝内胆管结石的高发地区，肝内胆管结石的特点为发病率高、复发率高、再手术率高、并发症多［1］。我院2000年1月—2008年2月收治215例肝内胆管结石患者，其中76例为复发病例，占总数的35.3%。回顾性分析76例复发性肝内胆管结石患者的临床资料，探讨该类患者再手术的近、远期疗效。　　 　　1　资料与方法 　　1.1　一般资料　 　　76例复发性肝内胆管结石患者中，男22例，女54例；年龄20～77岁，平均年龄48.6岁。大部分为低收入（农村五保户或城市低保对象）。入院前病程10 d～15年。主要症状：黄疸25例，占32.9%；腹痛49例，其中剑突下痛9例，右上腹痛23例，上腹部痛13例，复合痛4例；发热（以入院腋表测量为准）13例，占17.1%。 　　 　　患者既往治疗情况：最末一次手术为内镜逆行胰胆管造影