多次胆道术后再次胆道手术的临床分析

目的总结多次胆道手术后再次胆道手术的原因、临床特点及处理经验。方法回顾性分析2009年3月至2011年9月期间,解放军总医院第一附属医院肝胆外科收治的9例已于外院行3次以上胆道手术的再次胆道手术患者,对这些病例的临床资料进行分析。结果本组病例中再次手术的主要原因是胆道狭窄6例(66.7%),肝胆管结石复发合并胆管炎3例(33.3%)。本次手术方式分别为1例带血管蒂胃瓣修复,8例胆肠Roux-en-Y吻合,其中l例附加肝左外叶切除。术后随访3～18个月,胆道感染的症状消失,肝功能基本正常。结论多次胆道术后再次胆道手术的主要原因是胆道狭窄,对于多次胆道术后需再次手术的病例,术前利用影像学对病情准确评估,制定合理的治疗方案,提高手术技能以及做好围手术期的处理是保证手术成功的关键。

Clinical analysis of biliary duct reoperation after biliary duct multiple operations

Objective To summarize the causes,clinical features and therapeutic experiences of biliary duct reoperation after biliary duct multiple operations.Methods Retrospective study of 9 patients were included who underwent biliary duct reoperation after at least 3 biliary duct operations between March 2009 and September 2011 in our hospital.Results The causes of reoperation were bile duct stricture in 6 cases(66.7%)and recurrent bile duct stones with cholangitis in 3 cases(33.3%).8 patients underwent Roux-en-Y hepaticojejunostomy,and one of them received left lateral hepatectomy.One patient received pedicled gastric wall.Follow-up in 9 patients for 3-18 months found no cases of biliary duct infection and significant abnormal liver function.Conclusion The main cause of biliary duct reoperation after biliary duct multiple operations was bile duct stricture.For those complicated cases,preoperative evaluation of patient′s condition was accurately done by imageology,optimal choice of surgical procedures,excellent surgical skills and meticulous peri-operative period management were keys to success.