肝内外胆管结石术后再次手术的原因分析及防治对策

Analysis of the causes of reoperation and countermeasures of intra-and extrahepatic bile duct stones after op-eration

目的：探讨肝内外胆管结石术后再次手术的原因及防治对策。方法回顾性分析150例行肝胆结石手术后再次手术患者的临床资料，按照首次肝胆结石手术的原因将其分为三组：肝内胆管结石组即A组（100例）、胆囊结石组即B组（30例）、胆总管结石组即C组（20例）。分析各组再次手术的原因。结果肝内胆管结石再次手术患者中，肝胆结石再发患者98例（65．3％），胆总管囊肿和Caroli病35例（23．3％），胆肠吻合口狭窄17例（11．3％）；A组再次手术术后并发症发生率为44．0％，明显高于B组的13．3％和C组的15．0％（χ2＝9．32、5．88，均P＜0．05）；A组二次手术后结石以及炎症5年内复发率为32．0％，明显高于B组的6．7％和C组的10．0％（χ2＝7．67、3．97，均P＜0．05）。结论肝内胆管结石是肝胆结石术后再次手术的主要类型，且肝胆结石再发是其进行二次手术的主要原因。应在术前明确病因，针对不同类型结石患者采取不同手术方案，预防以及避免术后并发症的发生，能有效减少二次手术的概率，减轻患者痛苦。

Objective To explore the extrahepatic bile duct stones after reoperation cause analysis and coun-termeasures.Methods Clinical data of 150 patients with liver surgery gallstone surgery again were retrospectively analyzed,according to the first reason for liver from gallstone surgery will be divided into the three groups：group hepa-tolithiasis （ group A,100 cases） ,gallstones group （ group B,30 patients） ,common bile duct stones group （ group C, 20 cases） .The reasons for reoperation were analyzed.Results In intrahepatic bile duct stones reoperation patients, the recurrence of liver gallstones was 98 cases（65.3%）,common bile duct cysts and Caroli disease was 35 cases （23.3%）,anastomotic stenosis in 17 cases（11.3%）;The postoperative complication rate of group A（44.0%） was significantly higher than that of group B（13.3%） and group C（15.0%）（χ2 =9.32,5.88,all P〈0.05）;The sec-ondary and post-operative inflammation stone recurrence within 5 years of group A was 32.0%,which was significant-ly higher than 6.7%of group B and 10.0%of group C（χ2 =7.67,3.97,all P〈0.05）.Conclusion The intrahe-patic bile duct stones are the main types of reoperation after liver gallstones,gallstones and liver recurrence is the main cause of its secondary surgery.It should be make clear the disease cause of preoperation, take a different surgical options for patients with different types of stones,prevention,and avoid the occurrence of postoperative complications, which can effectively reduce the risk of secondary surgery to alleviate the suffering of patients.