9例腹腔镜胆囊切除术后再手术原因分析

目的：探讨腹腔镜胆囊切除术（LC）再手术原因及预防措施。方法：回顾分析我院1994年6月至2000年6月760例腹腔镜胆囊切除术后再手术的9例临床资料。结果：9例中胆管损伤3例，胆总管结石2例，胆瘘2例，出血2例。再手术率为1．18％。再手术的方法：胆总管探查、取石、T管引流2例，胆囊管、副肝管、胆囊动脉结扎术4例，胆总管原位吻合、T管支撑引流1例，胆肠吻合2例。9例全部治愈。结论：胆管损伤、胆瘘、胆道出血及胆管残余结石等并发症是腹腔镜胆囊切除术后再手术的根本原因；其次是术式选择不当，手术时机不当，初期技术操作不熟练以及未重视术中胆道造影的重要性所致。     

胆肠吻合术后再手术的原因及处理

目的 探讨胆肠吻合术后再手术的原因及处理方法。方法 回顾性分析1995年6月－1999年6月间28例胆肠吻合术后再手术的临床资料。结果 28例中,吻合口狭窄26例（92．8％）,伴左肝管狭窄9例,肿肝管狭窄3例,左右肝管狭窄5例。钡餐造影9例见胆管内返流,均为胆总管十二指肠吻合者。再手术方法：原吻合口切除再吻合3例,左肝外叶切除、肝门胆管整形与空肠Roux-en-Y吻合8例,左肝管、肝门胆管与空肠双口吻合2例,肝内胆管狭窄切开并整形后与空肠Roux-en-Y吻合15例。26例（92．8％）随访0．5－4年,仅1例（3．8％）间有轻度感染症状。结论 胆肠吻合口狭窄是再手术的根本原因,其次是术式选择不当、肝胆管狭窄未予解除及结石清除不彻底。再手术时应遵循清除结石、解除狭窄及通畅引流的原则,必要时结合肝段（叶）切除、吻合口支撑引流及术中、术后胆道镜处理。     

腹腔镜胆肠Roux-en-Y吻合术在胆道再次手术中的应用分析

目的:探讨腹腔镜Roux-en-Y胆管空肠吻合术(LRCJS)在再次胆道手术中的应用指征、操作技巧与疗效。方法:回顾分析2018年6月至2021年12月收治的首次胆肠Roux-en-Y吻合术后应用LRCJS再次行胆道手术的36例患者的临床资料。结果:首次实施Roux-en-Y胆肠吻合的原因：腹腔镜胆囊切除术中胆囊三角区严重粘连或解剖变异致胆管损伤后修复19例，肝内胆管结石术式选择不当7例，胆总管复发结石3例，Mirizzi综合征肝总管狭窄4例，胆总管囊肿2例，胆总管中段腺瘤1例。LRCJS再次手术前患者均行CT、MRCP等检查，诊断为胆肠吻合口瘢痕狭窄伴结石形成25例、肝总管狭窄伴结石4例、肝左叶胆管结石伴胆管炎7例。经术前评估内镜逆行胰胆管造影难以取出结石与纠正狭窄。25例行原胆肠吻合口拆开扩大+胆道镜取石再吻合术，4例行原胆肠吻合口拆开取石+左右肝管整形+胆肠吻合术，7例行肝左叶切除+右肝管空肠吻合术。随访6个月至4年，2例偶发右上腹疼痛、发热等急性胆管炎症状，余者均痊愈。结论:胆肠吻合术后再次行LRCJS具有痛苦少、创伤小、康复快的优势，但手术难度较大，有损伤腹腔脏器的风险，术者...     

胆管良性疾病再手术原因与诊治分析(附91例报告)

目的探讨胆管良性疾病再次手术的原因及其诊断与治疗。方法回顾性分析1991年1月至2005年12月期间我院收治的胆管良性疾病再次手术91例患者的临床资料。结果91例中接受2次手术者87例（95．60％），3次手术者4例（4．40％），无手术死亡。再次手术原因：结石残留或复发42例（46．15％），胆管损伤36例（39．56％），残留胆囊5例（5．49％），胆肠吻合口狭窄2例（2．20％），返流性胆管炎2例（2．20％），胆总管下端炎性狭窄2例（2．20％），肠瘘2例（2．20％）；再次手术方式：胆肠Roux-en-Y吻合、T管支撑56例（61．54％），肝叶切除13例（14．29％），肝门整形、肝管空肠Roux-en-Y吻合10例（10．99％），残余胆囊切除5例（5．49％），胆总管切开取石、T管引流3例（3．29％），胆管修复、T管支撑2例（2．20％），胆管对端吻合、T管支撑2例（2．20％）。结论降低结石残留以及预防胆管损伤是防止再次胆道手术的关键。进行胆道再次手术时应积极术前准备，制定合理治疗方案，以避免多次手术。     

胆道再次手术临床分析

目的探讨胆道再次手术的原因和对策。方法对1997年12月至2003年12月206例胆道再次手术的原因和术式进行回顾性分析。结果172例（83．5％）因结石复发和（或）残留主要行胆总管切开取石术、肝叶切除术、胆总管空肠Roux-Y吻合术及胆道镜取石术；9例（4．4％）胆道恶性肿瘤主要行根治性切除术、内外引流术；5例（2．4％）胆管损伤及3例（1．5％）十二指肠损伤主要行胆总管断端吻合术、T管引流术、胆肠吻合术、十二指肠修补及造瘘术；17例（8．3％）因其他原因再手术者主要行胆总管囊肿切除＋胆肠吻合术、腹腔引流术、腹腔探查、止血术等。结论①胆道再手术主要原因是残留结石和（或）复发；②为降低胆道再手术率，应强调术前诊断明确、选择正确术式和审慎操作。     

Mirizzi综合征的手术治疗

目的探讨Mirizzi综合征的诊断和治疗。方法回顾性分析35例Mirizzi综合征患者的临床资料。结果男性13例，女性22例，平均年龄62．3岁。术前确诊为Mirizzi综合征14例（40．0％），术中确诊21例（60．0％）。Ⅰ型9例，Ⅱ型18例，Ⅲ型7例和Ⅳ型1例。13例行腹腔镜手术，成功9例，另4例（30％）中转开腹手术。腹腔镜手术包括胆囊切除术7例，胆囊部分切除、术中胆道造影和经瘘管胆总管T管置入2例。开放手术的26例中，9例行单纯胆囊切除术，17例行胆囊部分切除，其中15例胆总管内置入T管引流，2例行Roux-en-Y肝管空肠吻合。术后发生并发症5例（14．2％），包括胆瘘3例，切口和肺部感染各1例，均经非手术治疗痊愈。无医源性胆管损伤和死亡。33例获随访1～5年，情况良好。结论重视Mirizzi综合征的术前诊断和术中辨认，尤其在腹腔镜胆囊切除困难时更应警惕，及时中转可减少甚至避免胆管损伤。术中胆道造影有助于了解病理改变，胆囊部分切除可以降低胆管损伤的风险，术后胆总管内应常规置入T管。如遇胆管壁毁损严重，适宜行Roux-en-Y胆管空肠吻合。     

64例胆道良性疾病再次手术的回顾性分析

目的探讨胆道良性疾病再次手术的原因和方式。方法对2年间再次手术治疗的64例胆道良性疾病患者的临床资料进行回顾性分析。结果 64例患者中因再发肝内外胆管结石而行再次手术62例,因存在胆肠吻合口狭窄梗阻而再次手术2例。再次手术方式:21例采用胆总管切开取石,21例行胆总管切开取石并肝叶切除,14例行肝门部胆管空肠吻合,5例未更改前次手术的胆总管空肠吻合而只行取石治疗,2例行肝门部胆管空肠吻合U管引流纠正吻合口狭窄,1例只行胆总管空肠吻合口狭窄扩张。全组64例患者中再次手术后死亡1例。随访2年后,行肝叶切除和肝门部胆管空肠吻合的患者结石复发率低于只行取石治疗者(χ2=10.115,P=0.018),而肝门部胆肠吻合与胆总管空肠吻合组反流性胆管炎的发生率无明显差异(P=0.624)。结论病灶的残留和不合理的手术方式是导致胆道良性疾病再次手术的主要原因,病变肝叶的切除和合理的肝门部胆管空肠吻合可降低胆道良性疾病再手术率。     

胆道再手术原因和对策

目的探讨胆道再手术原因及对策。方法回顾分析我院1999年1月至2002年12月间共行了胆道手术2881例，其中因各种原因行胆道再手术260例；并对其首次手术方式，再次手术方式和再次手术原因进行了详细分析。结果109例行胆总管切开取石，其中33例同时行肝叶切除；32例行胆总管空肠Roux-Y吻合术；94例行胆道镜取石术；2例行胰十二指肠切除术；残余胆囊再切除1例；22例分别行引流、止血或修补术。再手术原因早期主要以胆漏（7．3％）、腹腔内出血（1．2％）为主。晚期主要以结石残留或复发（76．9％），胆管良性狭窄（11．5％）为主。结论胆道再手术主要原因是处理胆道手术并发症。为降低胆道再手术率应强调术前全面分析诊断、术中审慎操作，并结合胆道镜、B超及胆道造影等检查行根治性手术，术后加强抗感染预防炎性狭窄。     

胆肠吻合术后再手术原因及处理

目的探讨胆肠吻合术后再手术的原因及处理方法. 方法回顾性分析我院1999年1月～2004年12月21例胆肠吻合术后再手术患者的临床资料. 结果 21例中初次手术行胆总管囊肿肠吻合6例,胆肠侧侧吻合7例,胆肠端侧吻合7例,胆肠侧端吻合1例.术后19例结石复发或残留,14例吻合口狭窄.再手术方法:全组均行规范胆管空肠Roux-en-Y式端侧吻合术,加行左肝外叶切除4例,其中1例行左肝管、肝门部胆管与空肠双口端侧吻合. 结论原发胆道病未能根治或复发及胆肠吻合口狭窄是再手术的主要原因,其次是术式选择不当,手术不规范.再手术应遵循"去除病灶、解除梗阻、通畅引流"的原则,选择正确术式,规范操作,避免手术技术缺陷.     

机器人辅助下58例胆管恶性肿瘤的手术探索

目的:总结“达芬奇”机器人手术系统在治疗胆管恶性肿瘤的临床经验.方法 我院在2009年1月至2010年10月期间应用“达芬奇”机器人手术系统进行了180例肝胆胰及胃肠手术,其中涉及胆管恶性肿瘤58例,对其病例分布、手术过程和术后恢复情况进行分析、总结.结果 58例包括肝内胆管囊腺癌3例,均行肝脏楔形切除术；肝门部胆管癌36例,行解剖性左半肝切除术3例,肝外胆管切除+胆囊桥式胆道重建术3例,肝外胆管切除+胆肠Roux-en-Y吻合术14例,肿瘤切除+肝门部胆管重建术1例,姑息性肝内胆管外引流术5例和肝门T管“Y”式内引流术10例；胆囊癌10例,2例行胆囊及肝外胆管切除+胆肠Roux-en-Y吻合术,3例行胆囊切除术,1例行胆囊切除+肝内胆管外引流术,4例行胆囊切除+T管“Y’式肝门胆管支撑胆汁内引流术；胆总管中段癌1例,行根治性肝外胆管切除+胆肠Roux-en-Y吻合术；胆总管下段癌8例,均行胰十二指肠切除术.58例患者中2例中转开腹手助完成,中转率为3.4％.手术时间曲（6.18±1.71）h,术中出血量为(116.66±56.06) ml,输血量为(85.55±38.28) ml,术后下床活动时间为(9.10±2.91)h,进食时间为(14.95±4.35)h,住院时间为(12.81±4.29)d.术后发生漏胆3例,肝创面出血1例,胰肠吻合口漏2例,肺部感染1例和肾功能衰竭1例,总并发症率为13.8％；经止血、充分引流及抗感染治疗,6例恢复顺利,2例分别因严重肺部感染、肾功能衰竭分别于术后3周及4周死亡,总死亡率为3.4％.36例肝门胆管癌患者中,19例死亡（术后2个月4例,6个月5例,10个月8例,12个月2例）,11例生存良好（＞26个月4例,＞22个月3例,＞19个月4例）,6例需住院治疗.10例胆囊癌患者中7例死亡（术后3个月1例,5个月1例,8个月1例,11个月3例,12个月1例）,3例目前仍存活（＞17个月2例,＞13个月1例）.8例行胰十二指肠切除患者中5例死亡（包括中转开腹者,4个月2例,6个月2例,10个月1例）,余3例患者术后生存已超过2年,且目前状态良好.3例肝内胆管囊腺癌术后生存时间均超过1年.结论应用“达芬奇”机器人手术系统可以完成涉及胆管恶性肿瘤各种类型手术,对于部位深在、结构复杂的肝门部手术,其优势尤为突出,突破了腹腔镜在肝胆恶性肿瘤中的禁区.     

胆道再手术原因分析：附828例报告

目的:分析导致再次胆道手术的原因，以期减少胆道再手术率。方法:总结1990—1999年间收治的再次胆道手术患者828例的临床资料，对胆道疾病再次手术的原因进行归类分析。结果:再手术的主要原因是结石复发或残留，占65.10%;结石合并Oddi括约肌狭窄占33.82%;单纯Oddi括约肌狭窄占9.54%;胆管损伤性狭窄和胆肠吻合口狭窄占10.39%;胆道系统肿瘤占6.52%。结论:胆道再手术的主要原因仍以结石复发或残留为主，其次为Oddi括约肌狭窄;损伤性胆管狭窄等与手术有关的因素不容忽视。减少胆道再次手术的关键在于初次手术的彻底性和手术方法的合理性。     

Long-Term Results of Hepatic Resection for Hepatolithiasis

Long-term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic biliary strictures were studied. The left lateral and the right posterior segmental ducts were commonly and often simultaneously involved. Fourteen patients had multiple segmental involvement. Hepatic resection included left sided resection (n=27), right sided resection (n=6), and repeated bilateral resection (n=1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, cystadenocarcinoma, and dysplasia of intrahepatic ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent stones developed in 3 and 4 patients, respectively. Twenty-six patients had no remaining symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms caused by retained stones (n=2), recurrent stones (n=2), bile stasis (n=1), or neuralgia (n=1). In 4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean follow-up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients with right lobar or bilobar type, intra- and extrahepatic type, and confluence strictures, bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis, however, meticulous management of biliary tract abnormalities, particularly the posterior duct stricture, is mandatory.     

腹腔镜肝切除术治疗左肝内胆管结石的临床应用

目的 探讨腹腔镜肝切除术治疗左肝内胆管结石的技术与疗效。 方法 回顾性分析2011年1月至2016年12月完成67例腹腔镜肝切除术治疗左肝内胆管结石临床及随访资料。 结果 全部67例患者合并左半肝或左外叶肝萎缩,腔镜手术方式包括左外叶肝切除48例、左半肝切除19例。其他腹腔镜下联合术式包括：胆囊切除术52例、胆总管探查术43例、T管引流术39例,胆总管一期修补术4例。手术切口长度（4.67±1.26）cm。术后发生胆漏3例,均经引流观察后自愈;1例因术后腹腔大出血合并胆瘘再手术治愈;肝脓肿1例,膈下脓肿1例,均经穿刺引流治愈。 结论 腹腔镜肝切除术治疗左肝内胆管结石安全可靠,术中应尽量取净其他胆道残余结石并连续紧密缝合左肝管残端。如结石已被取净胆总管的探查和T管引流并非必需。     

Reoperation of Biliary Tract by Laparoscopy: a Consecutive series of 26 Cases

Background: In the past, previous operation of biliary tract represented a contraindication to perform reoperation by laparoscopy. As experience with laparoscopic techniques and instrumentation has expanded, reoperation of biliary tract with laparoscope has become an accepted procedure in the management of cholelithiasis. We present our interesting experience with regard to reoperation of biliary tract by laparoscopy.

Material and methods: Laparoscopic operation of biliary tract was performed on 3,674 consecutive patients from April, 1992 till June, 2005. Among these patients, 26 had a previous open operation of biliary tract and their clinical data were retrospectively analyzed as follows: seven cases had complicated intrahepatic bile duct stones (restricted at hepatic duct of the first and second order). Diameter of common bile duct in patients with common duct stones was above 1.2 cm, the number of stones for each patient was more than 3 and all the biggest stones exceeded 1 cm. In the 26 patients, pre-operatively, stenosis of bile duct and malignant tumour were excluded by both radiological examination and detection of serological tumour markers.

Results: The mean operative time was 125 min (75–190 min). Reoperations of biliary tract by laparoscope were successfully accomplished in 25 patients. One patient was converted to open operation and the common duct stones were removed by right angle forceps through short incision. None of the patients developed any severe complication, all of them recovered and were successfully discharged. Three cases with retained calculuses were successfully cured by removing these through the sinus tract of T tube.

Conclusions: Laparoscopic procedure is minimally invasive, safe and feasible for laparoscopic experts in case of reoperation of biliary tract. It is also a first method for patients for whom endoscopic sphincterotomy is contraindicated.     

Reoperation of the biliary tract by laparoscopy: an analysis of 39 cases

BACKGROUND: Previously, prior biliary tract surgery was considered a contraindication to laparoscopic biliary tract reoperation. In this paper, we present our experience with laparoscopic biliary tract reoperation for patients with the choledocholithiasis for whom the endoscopic sphincterotomy has failed or is contraindicated. PATIENTS AND METHODS: A retrospective analysis was performed on data from the attempted laparoscopic reoperation of 39 patients, examining open conversion rates, operative times, complications, and length of hospital stay. RESULTS: Of 39 cases, 38 were completed laparoscopically: 1 case required a conversion to the open operation because of difficulty in exposing the common bile duct. Mean operative time was 135 minutes. Mean postoperative hospital stay was 4 days. Procedures included 3 cases of laparoscopic residual gallbladder resection, 13 cases of laparoscopic common bile duct exploration and primary duct closure of choledochotomy, and 22 cases of laparoscopic common bile duct exploration and choledochotomy with T-tube drainage. There was 1 case of duodenal perforation during dissection, which was repaired laparoscopically. There were 2 cases of retained stones. Postoperative asymptomatic hypermalasia occurred in 3 cases. There were no complications due to port placement, no postoperative bleeding, bile or bowel leakage, and no mortality. At a mean follow-up time of 18 months, there was no recurrence or formation of duct stricture. CONCLUSIONS: The laparoscopic biliary tract reoperation is safe and feasible for experienced laparoscopic surgeons and is an alternative choice for patients with choledocholithiasis for whom the endoscopic sphincterectomy has failed or is contraindicated.     

肝内胆管结石外科手术方法探讨

目的: 探讨肝内胆管结石并狭窄的手术治疗方法及其效果。方法: 总结8年间住院的165例肝内胆管结石并胆管狭窄患者的外科手术治疗情况。其中A组85例行肝叶(或肝段)切除的各种术式，同时行胆管空肠吻合40例，肝断面扩张胆管、肝门胆管与空肠双口吻合10例，T管和U管引流分别为21例和14例；B组80例行非肝叶(或肝段)切除术的各种术式，其中胆总管切开取石+T管引流23例，胆总管切开取石+U形管引流15例，胆肠吻合+胆总管取石42例。肝门部肝胆管狭窄整形46例。结果: A组无手术死亡；随访2～7年，术后残留结石4例，残石率4.71%；症状复发3例，复发率3.53%，无再手术者。B组无手术死亡；B组随访2～7年，术后残留结石12例，残石率15.00%。10例术后常有上腹隐痛或发热，症状复发率12.5%。术后经胆道镜取石5例，其余6例中有3例再次行肝叶切除治愈。结论: 肝段(叶)切除联合其他手术是治疗肝内胆管结石较为理想而有效的手术方式。     

肝胆结石术后再次手术的原因分析及防治对策

目的探讨肝胆结石手术后再次手术的原因及对策。方法回顾性分析肝胆结石术后再次手术的患者259例,其中因胆囊残株炎行胆囊残株切除术3例 因胆总管结石行胆总管切开探查取石＋T管引流14例,行EST3例 因医源性胆道损伤行胆肠吻合＋T管引流9例 因肝内胆管结石残留或复发行肝叶（段）切除＋T管引流（或肝肠吻合）188例 因胆肠吻合口狭窄行胆肠吻合14例（其中4例合并结石） 因胆总管囊肿行胆总管囊肿切除＋胆肠吻合11例 因Caroli病并结石行肝叶（段）切除＋T管引流9例,因胆管肿瘤行根治术或T管引流3例 因意外性胆囊癌行根治术5例。结果再手术后发生并发症48例（18.5%）,均经保守治疗治愈。均获随访,平均2（0.5～5）年,244例病人获得较好效果,优良率达94.2%。结论术前对病情的准确判断与充分的术前准备、正确的手术方法以及术后综合治疗是预防肝胆结石手术后再次手术的关键。     

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??Clinical efficacy of laparoscopic liver resection in treatment of recurrent hepatolithiasis in patients with history of multiple biliary tract surgery LI Wei-nan, LI Qiang, XU Jian, et al. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical University; Hepatobiliary and Pancreatic Intestinal Institute, North Sichuan Medical University, Nanchong 637000, China
Corresponding author??LI Jing-dong, E-mail:lijingdong358@126.com
Abstract Objective To investigate the clinical efficacy of laparoscopic liver resection in treatment of recurrent hepatolithiasis in patients with history of multiple biliary tract surgery. Methods The clinical data were collected from Affiliated Hospital of North Sichuan Medical University between May 2015 and May 2017. All patients had two or more history of biliary tract surgery. Results Among the 12 cases, 8 cases received exploration of the bile duct+hepatic segmentectomy (lobectomy)+T-tube drainage, 2 case received exploration of the common bile duct+hepatic segmentectomy (lobectomy)+hilar bile duct plastic surgery, 2 cases received exploration of the common bile duct and choledochoscope through the bilioenteric anastomosis Roux-Y jejunal loop. The mean operation was 285(238—348) min and the intraoperative blood loss was 484(396—627) mL. Four patients were conducted blood transfusion treatment, and the blood transfusion amount about 356??200—800??mL. The portal triad clamping were used in the patients. In 12 patients, duodenal plasma muscular injury in 1 case, transverse muscular injury in 1 case, the transverse colon full-thickness injury in 1 case, stomach plasma muscular injury in 3 cases. The anal exhaust time was (1.6±0.8) d and the ostoperative hospital stay was (9.6±4.2) d in the 12 patients; 7 cases of postoperative complications, the area of effusion in 2 cases, abdominal cavity effusion in 3 cases, bleeding in 1 case, bile leakage in 2 cases, the residual stone in 3 cases (1 case of the area at the same time merge effusion and peritonealeffusion, 1 case with residual stone and bleeding, 1 case of merger and residual stone, 1 case of abdominal cavity effusion combined the art district effusion and bile leakage).All complications were cured by symptomatic improvement. There was no surgery patients in perioperative period. During the follow-up, it could be completely asymptomatic in 9 cases. Three cases had occasional mild cholangitis sometimes. The "T" tube indwelling off after 2 months in a case of residual stones patients, and put the catheter in sinus tract immediately. Three patients with residual stones were cured after remove residual stones with electron choledochoscope with 1 to 3 times. Conclusion Based on evaluating patients’ condition sufficiently, the rich experience of laparoscopic hepatectomy and the experience of diagnosis and treatment of a variety of difficult condition in hepatolith disease, clinical curative effect is feasible and reliable in the recurrent hepatolith patients with the history of multiple biliary surgery to use laparoscopic liver resection.     

腹腔镜肝切除术治疗多次胆道手术复发性肝胆管结石疗效分析

目的 探讨腹腔镜肝切除术在治疗经多次胆道手术的复发性肝胆管结石病人中的临床疗效。方法 通过收集2015年5月至2017年5月因复发性肝胆管结石于川北医学院附属医院行腹腔镜肝切除术病人的临床资料,所有病人既往均有≥2次的胆道手术史。结果 12例病人中,8例行胆管切开取石+肝叶（肝段）切除+T管引流术,2例行胆管切开取石+肝叶（肝段）切除+肝门胆管整形术,2例行残端胆管切开取石+肝叶（肝段）切除+Roux-Y空肠盲袢切开胆道镜取石术。12例病人手术时间为285（238～348）min,术中出血量484 （396～627） mL,其中4例病人术中行输血治疗,输血量356（200～800）mL;12例病人均行第一肝门阻断。12例病人中,十二指肠浆肌层损伤1例,横结肠浆肌层损伤1例,横结肠全层损伤1例,胃浆肌层损伤3例。12例病人肛门排气时间（1.6±0.8）d;术后住院时间（9.6±4.2）d;7例术后发生并发症,其中术区积液2例、腹腔积液3例、出血1例、胆汁漏2例、残石3例（其中1例同时合并术区积液及腹腔积液、1例合并残石及出血、1例合并腹腔积液与残石、1例合并有术区积液及胆汁漏）。所有并发症均经对症治疗后好转,围手术期无再次手术病人。随访过程中,其中9例完全无症状,3例偶有轻度胆管炎发作。1例残石病人在T管留置2个月后脱落,及时放置导尿管。3例残石病人经T管电子胆道镜经1～3次取尽结石。结论 在充分评估病人病情、拥有丰富的腹腔镜肝切除术经验及拥有肝胆管结石病中的各种疑难病情的诊治经验的基础上,腹腔镜肝切除术治疗合并多次胆道手术的复发性肝胆管结石病人技术可行,临床疗效可靠。