胆道再手术的原因及对策

目的：探讨胆道再手术的原因和对策。方法：对1994年12月－20000年12月间胆道再手术102例进行回顾性分析。结果：75例行胆管切开取石，其中12例同时行肝叶切除，5例胆总管十二指肠合改行胆总管空肠Roux-en-Y吻合或再做其他术式，12例胆道恶性肿瘤分别行根治术，内外引流和PTCD，4例行胆管整形和胆肠吻合术，4例行囊肿切除胆肠Roux-en-Y吻合，2例行残余胆囊和胆囊残株炎切除，胆道再手术主要原因是结石复发（52．0％），残石（21．6％），恶性肿瘤（11．8％），术式选择或操作不当（8．8％），及胆管狭窄（3．9％），续集：为降低胆道再手术率，强调应明确术前诊断，采用正确的术式，术中胆道镜，胆道造和B超检查，审真操作，积极进行根治性手术，尽量避免急诊手术和术后经T管窦道取石。

CAUSES AND COUNTERMEASURE OF REOPERATION FOR PATIENTS WITH BILIARY TRACT DISEASES :A REPORT OF 102 CASES

Objective To study the causes and countermeasure of reoperation for patients with biliary tract diseases.Methods From Dec.1994 to Dec.2000,102 reoperated cases with biliary tract diseases were analyzed retrospectively.Results 75 cases underwent choledocholithotomy,of whom 12 combined lobectomy concurrently.5 cases treated with choledochoduodenostomy were altered for Roux-en-Y choledochojejunostomy,or received extra operation after primary procedure.12 cases with malignant tumors of biliary tract underwent radical resection,biliary drainage and PTCD respectively.4 cases subjected to biliary reconstruction and bilioenteric anastomosis.4 patients with choledochal cyst received cystectomy and bilioenteric anastomosis.Resection was performed in 2 patients with residual cholecyst and cystic duct.Recurrent and residual duct stones (52.0% and 21.6),malignant tumors of biliary tract(11.8%),unsuitable operative patterns(8.8%)and bile duct strictures(3.9%)were responsible for reoperation of biliary tract diseases.Conclusion To decrease reoperation rate,it should be emphasized to confirm diagnosis preoperatively,adopt suitable operative pattern,employ choledochoscopy,cholangiography and B ultrasonography intraoperatively,operate carefully and precisely,do radical resection of malignant neoplasams more actively,refrain from emergency operation as far as possible and remove the residual stones through cholangioscopy via T fistula postoperatively.