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肝胆管结石病具有高结石残留率、高结石复发率、高并发症率的特点,相当一部分病人需要接受再次甚至多次手术治疗。术前缺乏详细而全面的诊断和评估,手术方式、手术时机选择不当,术中缺乏必要的手术器械以及医源性胆道损伤后结石再生是导致多次手术的主要原因。胆道再次手术远较首次手术复杂,手术难度大,并发症发生率高,要求术者术前对病人的疾病状态进行充分评估,制定个体化治疗方案,选择合适的手术时机,鼓励选择以肝叶/段切除为基础的合理的手术方式,完备各种手术器械及设备,术后坚持追踪复查、早期处理并发症,以期最终降低术后结石复发率及再次手术率。

The cause of Hepatolithiasis reoperation and treatment decisions

Hepatolithiasis with the characteristics of higher rate of stones residual/recurrence and complication resulting a considerable proportion of patients set to undergo surgery several times.This adverse result was mainly caused by reasons below:incomprehensive preoperative diagnosis and assessment,unsuitable operation methods/timings,lacking of necessary surgical instruments and iatrogenic injury.Bile duct reoperation was complicated than that for the first time,which requiring a preoperative assessment of disease status to develop individualized treatment programs.The segmental hepatectomy with full equipped surgical instruments was promising and effective for patients with hepatolithiasis.Long term follow up as well as the treatment of postoperative complications in early stage were also advised.We will encourage the above methods combined with a view to ultimately reduce the postoperative risk of stone recurrence and reoperation.