胆肠吻合术后再手术68例原因分析

Reasons of reoperation after cholangioenterostomy and its prevention measures( a report of 68 cases)

目的探讨胆肠吻合术后再手术的原因,提出有效的预防方法。方法对2004-03-2014-03该院进行胆肠吻合术后再次手术68例患者的临床资料进行回顾性分析,分析胆肠吻合术后再手术的原因,对预防方法进行探讨。结果再手术原因前三位的是肝胆管残留结石、胆肠吻合口狭窄和结石复发,共63例,占92.65%。再手术后并发切口感染4例,3例反复出现轻微上腹痛,随访2年,1例胆管恶性病变患者于术后7个月死于全身衰竭。其余67例患者无复发,疗效满意。结论胆肠吻合术后再手术的原因较多,包括原发病灶去除不彻底、胆肠吻合口狭窄、初次手术方式选择不当等原因。严格把握胆肠吻合术手术指征和胆肠吻合术的规范操作有助于降低再手术率。

Objective To investigate the reasons of reoperation after cholangioenterostomy and put forward effective methods for prevention. Methods The clinical data of 68 patients undergoing reoperation after cholangioenterostomy from March 2004 to March 2014 were analyzed retrospectively. The reoperation reasons were analyzed and the prevention methods were discussed. Results The top three reasons for reoperation included residual bile duct stones,anastomotic stricture and stone recurrence,accounting for 92. 65%（ 63 /68）,postoperative wound infection was found in 4 cases,repeated mild upper abdominal pain in 3 cases. The patients were followed up for two years,one patient with malignant bile duct lesions died of systemic failure seven months after operation. The remaining 67 patients were not found recurrence with a satisfactory effect. Conclusion The reasons of reoperation after cholangioenterostomy include the incomplete removal of the primary lesion,anastomotic stricture and improper manner at initial stage of the surgery. Strictly controlling cholangioenterostomy indications and taking standard operation helps reduce the reoperation rate.