111例胆道非计划再手术体会

Reflections on 111 cases of non-planned bile duct reoperation

目的探讨胆道非计划再手术的原因、策略及手术要点。方法对1996年2月至2009年4月111例胆道非计划再手术的临床资料进行回顾分析。结果胆道非计划近期再手术的主要原因是医源性胆管损伤,共7例,占近期病例的63.6%;远期再手术的主要原因是胆管残余或复发结石,共66例,占远期病例的66.0%。远期组再手术方式以肝叶段切除合并胆肠吻合或T形管引流为主,共35例,占远期病例的35.0%。胆道再手术后并发症发生率为14.4%。结论胆道非计划再手术既有胆道疾病本身原因,也有医源性因素。重视术前准备、术中仔细探查、选择合理手术方式是减少胆道再手术的重要因素。把握好胆道再手术的策略是再手术成功的关键。

Objective To analyze the causes,prevention and points on treatment of bile duct reoperation.Methods The clinical data of 111 cases of bile duct reoperation in 81 hospital of PLA from February,1996 to April,2009 were investigated.Results The main cause of reoperation was iatrogenic bile duct injury,which occurred in 63.6% of the recent group.The main cause of reoperation lies in remain or recrudesce gallstones in bile ducts,which occurred in 66.0% of the long term group.Main surgical treatments of bile duct reoperation include lobar or segmental resection（35.0%） with Roux-en-Y hepatic ojejunostomy or T-tube drainage.The complication rate of reoperation was 14.4%.Conclusion Non-planned bile duct reoperation is mainly caused not only by the bile duct diseases but also by iatrogenic factors.Therefore,to reduce reoperation in bile ducts requires attaching great importance to the latent danger of bile duct operation,sufficient pre-operation preparation,and careful observation during operation.The key factor for a successful reoperation is to grasp the bile duct reoperation strategy.