摘要
目的分析胆道结石术后再手术的原因及其对策,探讨胆道结石的治疗经验,减少再手术率。方法对医院近10年胆道结石术后再手术的60例患者临床资料结合文献进行回顾性分析。结果本组共60例,其中男24例,女36例,年龄25～74岁(平均49.5)岁。残留或复发结石的部位:肝内胆管结石23例,胆总管结石15例,肝内外胆管结石22例,胆肠Roux-en-Y吻合术后狭窄并结石嵌顿4例。其中行2次以上手术的是43例,3次以上手术9例,4次以上手术4例。结论胆道结石术后再次手术原因有:①疾病因素,病情危急不宜或病变复杂无法行彻底手术而致结石残留需再次手术。②医疗因素,医师的经验技术及医疗条件欠缺致结石残留或复发需再次手术。预防再次手术的措施及再手术体会:避免急诊手术尽量争取择期手术。遵循"取净结石,清除病灶,解除狭窄,通常引流"十六字治疗方案,通畅引流的关键是解除胆道狭窄。肝内胆管结石的规则性肝切除治疗疗效确切。胆道镜应用是手术的组成部分,对于降低肝胆管结石术后残留结石率具有重要价值。
Objective To analyze and find the solution to reoperation of cholelithiasis, to explore the experience of reoperation for re- ducing the rate of reoperation. Methods The clinical data of 60 cases were analyzed retrospectively, which included 24 men and 36 women for cholelithiasis operated in the last 10 years. Results 60 patients ranged from 25 to 74 years old （the median age 49.5）. The recurrent and residual bile stone spot： intrahepatic stones 23 cases, the common bile duct stones 15 cases, the stricture and calculi after eholangio-jejunal anastomosis ofRoux-en-Y 4 cases. 43 patients received operation twice and 9 patients received operations over 3 times. Conclusions The causes of reoperation were： （~）the stones were residual because the operation were undergone in patients accompanied acute bancreatitis or acute cholangitis; ~ the stones were residual because of the inappropriate surgery method and the requirements of medical treatment were imperfect. Intrahepatie bile duct constriction was very important. The emphases ofreoperation is the exposure of hepatic portal duct. Hepatectomy should be performed for primary intrahepatic stones. Intraopertive or postoperative cholangioscopy is an effective measurement during the operation, which can markedly decrease the incidence of residual stones.
出处
《临床医学工程》
2011年第3期385-386,共2页
Clinical Medicine & Engineering
关键词
回顾性分析
胆道结石
再次手术
纤维胆道镜
Retrospective analysis
Bile duct stone
Reoperation
Choledochoscope
