肝胆管结石胆肠吻合术后再手术原因浅析

目的探讨肝胆管结石胆肠吻合术后再手术的原因。方法对近13年来19例胆肠吻合术后再手术的肝胆管结石患者临床资料进行回顾性分析。结果再手术发现肝内胆管结石18例,胆肠吻合口狭窄5例、左肝管口狭窄11例、右肝管口狭窄6例、左肝外叶萎缩7例、右肝后叶萎缩2例。原肠肠吻合口呈T形5例、倒Y形2例。上行肠袢30、60cm各1例、居于结肠前位4例。合并胆管癌3例。结论严格掌握手术适应症,选择正确的术式,并注意提高手术操作技术是预防肝胆管结石胆肠吻合术后再手术的关键。

THE CAUSES OF REOPERATION AFTER CHOLANGIOENTEROSTOMY FOR HEPATOLITHIASIS

Objective To explore the causes of reoperation after cholangioenterostomy for hepatolithiasis.Methods The clinical data of 19 cases who had experienced cholangioenterostomy in the last 13 years were analyzed retrosepectively.Results 18 cases of the reoperative patients had stones located in the intrahepatic ducts,stricture of chole-intestinal stoma in 5 cases,stricture of left hepatic duct in 11 cases,stricture of right hepatic duct in 6 cases,atrophy of external lobe of left liver in 7 cases,atrophy of posterior lobe of right liver in 2 cases.The shapes of intest-intestinal stoma were like "T" in 5 cases and like inverse "Y" in 2 cases.The upper ansa interstinalis were 30cm in 1 case,60cm in 1 case and anteposition of colon in 4 cases.Complicating cholangiocarcinoma was found in 3 cases.Conclusion For hepatolithiasis,grasping operative indication strictly,choosing right operative style and elevating operative skills are the keys to prevent reoperation after cholangioenterostomy.