再次胆道手术原因分析及其对策

Analysis and countermeasures of biliary tract reoperation

目的:探讨再次胆道手术的原因,以期总结对策,降低再次手术率。方法:对73例行再次胆道手术患者的临床资料进行回顾性分析。结果:再次胆道手术的主要原因是结石残留或结石复发,占71.23%(52/73)。其次是医源性原因占13.70%(10/73),其中,内镜治疗不成功占40%(4/10),胆管损伤及残余胆囊各占30%(3/10),良性胆道狭窄占4.11%(3/73)。结论:再次胆道手术的主要原因仍是结石残留或结石复发;其次,内镜治疗不成功及损伤性胆管狭窄等医源性因素不容忽视,前次手术的彻底性及术式的合理应用是减少胆道再手术的关键。

Objective：To investigate the causes of reoperation after biliary tract surgical intervention, in order to decreasing the rate of biliary tract reoperation. Methods： A retrospective study in 73 patients undergoing biliary tract reoperation was carried out. Results： The main reason of reoperation was residual or recurrence bile duct stone （71.23% ,52/73）.The second was iatrogenic reason （13.70%, 10/73）, which the endoscopic treatment unsuccessful accounted for 40% （4/10）, bile duct injury and residual gallbladder were both 30% （3/10）. And benign biliary stricture （4.11%, 3/73）.Conclusions：Residual or recurrence bile duct stone was the main cause for biliary tract reoperation, also the iatrogenic reason such as endoscopic treatment unsuccessful and traumatic bile duct stenosis was indispensable. Thoroughness of the previous operation and rationality of operative procedure are the keys to decrease biliary tract reoperations.