117例肝胆结石术后再次手术的原因分析及防治对策

The Cause and Countermeasure of Operation for Hepatic Calculus again in 117 Cases

目的探究肝胆结石术后再次手术的原因及防治对策。方法随机选取并回顾分析2006年6月至2012年6月于我院行肝胆结石术后再次手术患者117例,对其再次手术原因、并发症及复发率进行统计。结果肝胆结石再发患者97例(82.9%),胆总管囊肿和Caroli病9例(7.69%),胆肠吻合口狭窄11例(11.34%)。对三组患者进行比较,肝内胆管结石患者并发症发生率及3年内结石及局部感染复发率高于其他两组结石患者。结论首次手术前明确诊断和确认患者病灶局部位置,制定完善正确的手术方案,术中注意操作防止医源性损伤是预防再次手术的重要方法。

Objective To study the cause and countermeasure of operation for hepatic calculus again. Methods Choosed 145 patients of operation for hepatic calculus again from Jan. 2004 to Jan. 2007 to divide into 3 groups, and there were 96 cases of hepatolithiasis （66.2%）, and 31 cases choledoeholithiasis （21.3%）, 31 cases of cholelithiasis （21.3%）. Followed up 5 years and study the rate of relapse. Results Studying the cause of operation for hepatic calculus again, there were 34 cases of hepatic calculi recurrence （75.55）, 26 cases of choledochocyst and Caroli disease （14.9%）, and 10 cases of bravery intestinal anastomosis stricture （6.67%）. And there was no significant difference between these three groups （P〈0.05）. Conclusion We should diagnose clearly and make surgical planning to prevent nosocomial infection.