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。

Cause Analysis and Strategies of Reoperation for Biliary Lithiasis

Objective To investigate the causes of reoperation for biliary lithiasis and its strategies. Methods 259 cases underwent reoperation for biliary lithiasis were retrospectively reviewed,with regard to the failure of preliminary surgery and the correspondent strategy. The reoperations included 3 of stubble cholecys- tectomy for stubble cholecystitis, 14 of common bile duct exploration plus T-tube drainage and 3 of EST for common bile duct stones, 9 of cholangio-jejunostomy for iatrogenic biliary tract injury, 188 of hapatic lobectomy or segmenteetomy plus T-tube drainage or cholangio-jejunostomy for intrahepatic biliary lithiasis residual or re- lapse, 14 of cholangio-jejunostomy for stoma stricture, 11 of choledochocyst resection plus cholangio-jcjunosto- my for choledochoeysts, 9 of hepatic lobectomy or segmenteetomy plus T-tube drainage for Carolig diseases, and 8 of radical resection for unexpected biliary or gallbladder carcinoma. Results 48 cases occurred complica- tions after reoperation and were cured by expectant treatment. In accordance with the 0.5 to 5 years follow-up, 244 cases were cured, showing a curative rate of 94.2%. Conclusion The reoperation for biliary lithiasis may be avoided by an accurate preoperative assessment,sufficient preoperative preparation,appropriate intraop- erative procedure and comprehensive postoperative treatment.