胆道再手术10年变迁及其新认识

目的总结十年间胆道再手术变化规律及防治成果,探索新认识。方法比较分析1993年1月-2002年12月十年间前后两个阶段（第一阶段86例,第二阶段107例）193例胆道再手术病人胆道再手术率、再手术原因和再手术方式的差异。结果两个阶段再手术原因均以胆道结石（或伴胆管狭窄）为主要原因,其次为胆道相关肿瘤和胆道损伤;但第二阶段胆总管结石和胆漏比例均低于第一阶段。两个阶段均有近半数再手术与初次手术直接有关;但第二阶段因残余胆囊或胆囊结石而再手术的比例高于第一阶段,其他残余结石比例低于第一阶段。两个阶段再手术术式相似;第二阶段行胆囊切除和肝叶切除比例高于第一阶段,胆总管切开取石的比例则低于第一阶段,新发现肿瘤切除率高于第一阶段。结论10年间胆道再手术是有进步的,但成效并不大。初次手术时要注意手术安全性和病灶清除彻底性的合理统一;也要重视防止继发性病变及其非手术治疗。

CHANGE IN BILE DUCT RE-OPERATION 10 YEARS AND NEW RECOGNITION

Objective To summarize the rule of change in bile duct re-operation in 10 years,and to have an new understanding of bile duct re-operation.Methods The clinical data of 193 patients undergoing bile duct re-operation from Jan 1993 to Dec 2002 were divided into two phases,and the differences of bile duct re-operation rates,causes and procedures between the two phases were analyzed.Results The most common cause for re-operation was bile stone(or accompanied by bile duct stenosis) in both phases,the next were biliary correlated tumor and bile duct injury;but the ratios of common bile duct stone and bile leakage in the 2nd phase were lower than those in the 1st.Half re-operations were directly related to the initial operations in both phases;But the proportions of remnant gallbladder and cholecystolithiasis in the 2nd phase were higher than that in the 1st while the proportion of other residual stone in the 2nd was lower than that in the 1st.The procedures of re-operation in two phases were similar,but the ratios of cholecystectomy and hepatectomy in the 2nd were higher than those in the 1st while ratio of choledocholithotomy in the 2nd was lower than that in the 1st,and the resection rate of tumor new-found in the 2nd was higher than that in the 1st.Conclusion Some advances have been made in the bile duct re-operation in the past ten years.It is necessary to pay attention to the reasonable unification of the safety and thorough eliminating focus during the initial operations.In addition,the regenerated pathological changes should be prevented or treated with non-operative methods.