胆囊切除术后再手术患者临床分析及防治措施

CLINICAL ANALYSIS OF REOPERATION IN PATIENTS WITH CHOLECYSTECTOMY AND ITS PREVENTION

目的探讨胆囊切除术后再次手术的原因、处理的体会及其防治措施。方法对近5年该院收治的胆囊切除术后仍有症状和出现并发症,经B超、MRCP、ERCP、消化道造影、腹腔穿刺、胆道镜及胃镜等检查发现需再次手术的54例患者的临床资料进行回顾性分析。结果主要原因和并发症:再发胆总管结石25例,胆管损伤9例,残留胆囊5例,腹腔出血及残留胆囊结石伴胆总管结石各3例,胆总管下段炎性狭窄及胆囊切除术后再行EST术后反复胆管炎各2例,胆管癌、意外胆囊癌、十二指肠憩室伴反复发作胰腺炎、胆总管空肠侧侧吻合术后致吻合口处狭窄伴结石及漏诊胃癌各1例。54例患者根据不同病因行相应的手术治疗,包括残株胆囊切除术、剖腹探查止血、胆总管切开取石T管引流术、胆总管空肠ROUX-Y引流术、胆管外引流术、十二指肠憩室手术、EST术及胃癌姑息术等。再次手术后因胆道狭窄而多次手术4例,其余均取得良好效果,无手术死亡。结论胆囊切除术后再手术的患者主要原因为胆管结石、胆管损伤和残留胆囊,经再手术治疗后效果较好。

Objective To explore the reasons,treatment experience and prevention measures of reoperation after cholecystectomy.Methods The clinical data of 54 patients with symptoms and complications after cholecystectomy in author＇s hospital nearly5 years,who underwent reoperation after B ultrasound,MRCP,ERCP,digestive tract visualization,abdominal puncture,choledochoscope and gastroscope,were analyzed retrospectively.Results The main reasons and complications were recurrent common bile duct stones in25 cases,bile duct injury in9 cases,residual gallbladder in5 cases,abdominal bleeding and residual cholecystolithiasis with common bile duct stones in 3 cases,common bile duct stricture and recurrent cholangitis after EST in 2 cases,common bile duct carcinoma,unexpected gallbladder carcinoma,duodenal diverticulum with recurrent pancreatitis,stenosis with calculi at the anastomotic stoma between common bile duct and jejunum and missed diagnosis of gastric carcinoma in1 case.All the 54 patients underwent reoperation according to different causes,including stump cholecystectomy,haemostatic laporatomy,choledocholithotomy and T tube drainage,bile duct jejunum ROUX-Y anastomosis drainage,external biliary drainage,duodenal diverticulum operation,EST operation and palliative surgery for gastric cancer.4 cases underwent repeated operation due to biliary stricture after the reoperation,the rest had achieved good results,no operation death.Conclusion The main reasons of reoperation after cholecystectomy are bile duct stones,bile duct injury and residual gallbladder,the good effect can be obtained after reoperation.