胆石症再次手术的原因与预防

The Causes of Reoperation of Cholelithiasis and Prevention

目的:探讨胆石症再次手术的原因及预防措施。方法:对我院过去5年收治的134例胆石症再次手术病例的临床资料进行回顾性分析。结果:胆石症再次手术主要原因为结石残留或复发(86.57%),医源性胆管损伤(4.48%),拔除T管后胆汁性腹膜炎(4.48%),残留胆囊炎伴结石(2.99%),胆肠吻合口狭窄伴结石(1.49%)等。再次手术方式以胆总管切开取石胆道镜检查取石"T"形管引流术、胆总管十二指肠侧侧吻合术,肝胆管-空肠Roux-en-Y吻合术,肝叶段切除,残留胆囊切除术为主。本组患者痊愈131例,死亡3例,死亡率2.29%,术后残石率5.17%。结论:对于胆石症,无论是首次手术还是多次手术,均应做好术前检查,制定周密的手术计划,利用胆道外科和肝脏外科技术,努力贯彻去除病灶,解除梗阻,通畅引流三原则,力争将残石率、复发率、再手术率降低到最低限度。

Objective：To study the causes and precautions of reoperation for patients with recurrent cholelithiasis.Methods：From Jan.2004 to Jan.2009,134 cases of recurrent cholelithiasis following operation were analyzed retrospectively.Results：The most common causes for reoperation in the cholelithiasis patients were residual or recurrence of calculi（86.57%）,and iatrogenic bile duct injury（4.48%）,biliary peritonitis after T-tube removal（4.48%）,residual cholecystitis with calculi（2.99%）,chole enterostomotic stenosis with calculi （1.49 % ）, et al. Choledocholithotomy, choledochoscope and T - tube drainage, side-to-side choledochoduodenostomy, Roux-en - Y hepatocholangioenterostomy, hepatolobectomy, residualchotecysteetomy were the main way of reoperation. One hundred and thirty-one patients in this group were cured, and 3 dead, the mortality was 2.29%, residual stone rate was 5.17%. Conclusion： No matter the operation or the reoperation of choleithiasis that need the consmmate examination and operation plantho roughly. We can use the technique of biliary tract and hepar surgery, to eliminate the primary lesion, to relive obstruction and to unobstruct drainage, try our best to reduce rate of calculus remaining relapse and reoperation to the lower limit.