胆道再次手术73例剖析.docVIP

胆道再次手术73例剖析 　　【摘要】 目的 分析胆道再手术原因,总结诊治经验及教训。方法 对1998年5月至2009年8月收治的73例胆道再次手术的临床资料进行回顾性分析。结果 胆道再次手术的主要原因是肝胆管结石残留或复发,占全组病例的79.4%,其次为胆管狭窄、医源性损伤、肿瘤,再手术的方式以胆总管切开取石、肝叶段切除、胆肠吻合为主。结论 胆道再次手术既有胆道疾病本身因素,亦有医源性因素;充分的术前准备及术前评估,结合内镜或术中超声或造影等,以“取净结石、解除狭窄、通畅引流、去除病灶、防治复发”为原则,选择合理手术方式是减少胆道再次手术的关键。 　　【关键词】 胆道再次手术;肝胆管结石;诊治 　　 　　The analysis of 73 patients with bile duct reoperation 　　 　　DENG Bo-tao. 　　General surgery department in the first hospital affilited Fujian Medical Uniersity,Fujian,Sanming 365000,China 　　 　　【Abstract】 Objective To analysis the Characteristics cause of bile duct reoperation.and 　　Summing up experiences and lessons.Methods Retrospective analysis of clinical data Right from May 1998 to August 2009 were treated 73 cases of biliary tract reoperation.Results Bile duct re-operation is mainly due to residual or recurrent bile duct stones, which occurred in 79.4% of the reviewed cases. The secondary causes were bile duct stricture, iatrogenic injury, tumor.Re-operation approach to the common bile duct stones, hepatic resection, biliary-enteric.Conclusion Biliary tract reoperation of biliary tract disease itself both factors as well as iatrogenic factors; adequate preoperative preparation and pre-operative assessment, combined with endoscopic, or intraoperative ultrasound or angiography, in order to take the net stones, lifted narrow, smooth drainage, removal of lesions, prevent recurrencethe principle of rational choice is to key to reduce the biliary tract surgical re-operation. 　　【Key words】 Bile duct reoperation;Bile duct stones;Treatment 　　 　　胆管结石是外科的一种常见病、多发病,胆道手术示腹部外科最常见的手术之一,由于胆道与肝、胰腺、十二指肠关系密切,结果复杂,解剖变异多,但随着现在诊疗技术的发展,如ERCP、PTCD、内镜支架、腹腔镜等。医源性损伤也增多,因此胆道再手术的难度增大、风险增大,成为胆道外科的热点及难点。本文回顾性通过我院1998年5月至2009年8月收治的73例胆道再次手术的临床资料,分析再手术的原因及诊治经验教训,以期达到减少胆道再手术的目的,现报告如下。 　　1 临床资料 　　1.1 一般资料 　　 　　表1 　　 　　73例胆道再次手术的原因及术式 　　 　　首次手术原因N% 手术方式 　　胆囊结石 810.9% 胆囊切除(大部为LC) 　　肝内外胆管结石4054.0%肝叶段切除、胆总管切开取石及T管引流、胆肠吻合术 　　胆总管结石1926.0% 胆总管切开取石、T管引流术 　　AOSC68.2% T管引流术、胆总管切开取