腹腔镜胆总管囊肿术后再手术原因及处理措施分析

Analysis of the Causes and Management of Reoperation After Laparoscopic Choledochocyst Operation

目的分析胆总管囊肿腹腔镜手术(LC)后再手术原因,并探讨其处理措施,以便为临床提供参考。方法通过回顾性分析的方式对郑州市第七人民医院2015年2月-2017年2月收治的胆总管囊肿LC术后再手术患者92例进行研究,纳入对象均有完整资料,回顾性分析再手术原因,并制定有效的措施处理,随访2年以上,总结效果。结果胆总管囊肿LC再手术的原因主要在于LC手术并发症,包括囊肿未切除或切除不彻底所致并发症、切除术后并发症,主要有反复发作胆管感染、囊肿癌变、胆管结石、吻合口狭窄及逆行性胆道感染;92例患者随访时间(2.4±0.4)年,再手术后均康复出院,随访期间发生4例肝道感染、1例结石复发、1例吻合口狭窄,因囊肿癌变再手术12例患者中4例死亡。结论囊肿未切除或切除不彻底所致并发症、切除术后并发症是导致胆总管囊肿LC手术患者再手术的主要原因,为了避免再手术,初诊时应结合影像学结合,根据不同分型选择合适的手术方案完整切除,再次手术时尽量将癌变囊肿完整切除,才能减少死亡。

Objective To analyze the cause of reoperation after the laparoscopic choledochocyst(LC)operation and discuss its treatment measure,so as to provide references for clinical practice.Methods A total of 92 patients of reoperation after LC operation in Zhengzhou Seventh People's Hospital from February 2015 to February 2017 were studied by means of the retrospective analysis.All included patients had complete data,the cases of reoperation were analyzed retrospectively,and the effective treatment measures were formulated.The patients were followed up for more than 2 years to summarize the effects.Results The main causes of the reoperation after LC operation is the complications of LC operation,including the complications caused by no or incomplete excision of the cyst and complications after resection,including recurrent bile duct infection,cyst canceration,bile duct stones,anastomotic stenosis and retrograde infection of bile duct.The 92 patients were followed up for(2.4±0.4)years,and recovered and discharged after reoperation.During the follow-up period,there were 4 cases of hepatic tract infection,1 case of stones recurrence,1 case of anastomotic stenosis,and 4 of the 12 cases who underwent reoperation for cancerous cysts died.Conclusion The complications caused by no or incomplete resection of the cyst and complications after resection are the main causes for reoperation of patients with LC operation.In order to avoid reoperation,the first diagnosis should be combined with imaging,choose the appropriate surgical scheme according to different types for complete resection,and try to completely remove the cancerous cyst during reoperation,so as to reduce the death.