良性胆道疾病再次手术的原因及对策(附119例报告)

目的：探讨良性胆道疾病再次手术的原因及对策。方法：对1988年6月至1998年6月十年间收治的119例良性胆道疾病再次手术病人的临床资料进行回顾性分析。结果：119例中接受2次手术者78例（65．55％），3次者30例（25．21％），4次以上者11例（9．24％），死亡4例（3．36％），初次手术方式，开腹胆囊切除术61例（51．26％），胆囊切除加胆总管探查术35例（29．41％），胆肠吻合术15例（12．61％），腹腔镜胆囊切除术8例（6．72％），再次手术的原因，残留或复发结石占首位，共43例（36．13％），胆管损伤或损伤性狭窄32例（26．98％），残留胆囊炎或伴结石23例（19．33％），胆肠吻合口狭窄13例（10．92％），Oddi括约肌狭窄4例（3．36％），其他原因4例（3．36％），结论：良性胆道疾病再次手术的对策；（1）提高术前确诊率，通过各种影像学及造影检查，详细了解胆道系统情况。（2）术中全面细致检查，充分运用胆道镜，胆道造影及术中B超检查，选择合理的术式，降低残石率。（3）根据胆道的损伤类型，合理把握初次手术时机，成形后的肝管空肠端侧Roux-en-Y吻合术是胆道重建术的最佳选择。

Causes and countermeasures of re-operation for benign biliary tract diseases: a report of 119 cases

Objective To explore the causes and countermeasures of re operation for benign biliary tract diseases. Methods The clinical data of 119 patients with benign biliary tract diseases undergoing re operation in our hospital from June 1988 to June 1998 were retrospectively analyzed. Results Seventy eight patients (65 55%) received operation twice and 30 (25 21%) underwent 3 operations. There were 11 cases (9 24%) needed 4 operations or more. Four cases (3 36%) died postoperatively. The procedures for the first operation were cholecystectomy in 61 (51 26%), cholecystectomy with exploration of common bile duct in 35 (29 41%), cholangiojejunostomy in 15 (12 61%) and LC in 8 (6 72%). The causes for re operation included residual and recurrent bile duct stones in 43 cases (36 13%), bile duct injury or stenosis after injury in 32 (26 98%), residual cholecystitis with or without stones in 23 (19 33%), stenosis after cholantiojejunostomy in 13 (10 92%), stenosis of Oddi's sphincter in 4 (3 36%) and other reasons in 4 (3 36%). Conclusions The countermeasures of re operation for benign biliary tract diseases are: 1) to increase preoperative diagnostic rate, understand conditions of biliary tract in detail by using imaging techniques and cholangiography;2) to examine comprehensively and carefully, employ choledochoscopy, cholangiography and B mode ultrasonography intraoperatively and choose appropriate operation procedures to decrease the rate of residual stones;3) to appropriately decide the first repair time according to injury type of bile duct. Roux en Y hepaticojejunostomy with cholangioplasty is the best operation for biliary tract reconstruction.