摘要
目的探讨肝胆管结石患者行胆肠吻合术后再手术的原因及其预防措施。方法回顾性分析肝胆胰外科2003年1月-2011年1月21例患有肝胆管结石行胆肠吻合术后再手术患者的临床资料及其随访情况。结果再次手术时发现肝内胆管结石患者13例,其中结石位于左肝患者4例、结石位于右肝患者5例、左右肝均有结石4例,左肝外叶萎缩2例、右肝萎缩3例、左右肝均萎缩3例。胆肠吻合口处瘢痕狭窄患者4例,吻合口处有结石患者1例,胆管癌1例,胆肠吻合口肿瘤患者1例。原胆肠吻合口为倒Y形1例,返流性胆管炎1例。再手术后胆肠吻合口出血1例,吻合口漏1例,手术创面渗血1例,随访患者21例,随访率100%,随访时间1～8年之间,平均3.5年。1例胆管癌及1例吻合口肿瘤患者均死亡,4例患者再手术后仍偶有胆管炎发作,其余15例患者腹痛症状基本消失。结论术前严格掌握肝胆管结石行胆肠吻合手术的适应症,术前对患者进行评估,选择正确的手术方式,术中精细的操作都是减少术后并发症、降低再次手术机率的重要措施。
Objective To explore the reasons and preventive measures of reoperation after cholangioenterostomy for hepatolithiasis.Methods Clinical data of 21 patients underwent reoperation after cholangioenterostomy for hepatolithiasis in our hospital from January 2003 to January 2011 were analyzed retrospectively.Results The reoperation found stones in intrahepatic bile duct in 13 cases,the stones were located in the left hepatic in 4 cases,located in the right hepatic in 5 cases,in the hole hepatic in 4 cases,left hepatic lobe atrophy in 2 cases,and right hepatic lobe atrophy in 3 cases.Both left and right hepatic lobe atrophy in 3 cases,biliary enteric anastomosis stenosis in 4 cases,stones in stoma induced 1 case,complicated with bile duct carcinoma in 1 case,tumour in biliary enteric anastomosis in 1 cases,1 case of primary anastomosis inverted Y shape,cholanqitis in 1 case,the paries posterior of stoma bleed after the reoperation in 1 case.The surface of operation wound bleed in 1 case.The bile streamed in 1 case.21 cases were followed up,the rate was 100%.The following up time was 1 to 8 years,the average time were 3.5 years.1 case of cholangiocarcinoma and 1 case of bile duct carcinoma died.The symptom of other patients disappeared.The cholanqitis happenned sometimes after the reoperation in 4 cases.Conclusion Strictly control the operation indications before the operation,choose the correct operation,careful operation technology were the crux of the matter to reduce the syndrome and prevent the reoperation of hepatolithiasis biliary enteric anastomosis after the operation.
出处
《中华全科医学》
2013年第8期1224-1226,共3页
Chinese Journal of General Practice
关键词
肝胆管结石
胆肠吻合术
再手术
Hepatolithiasis
Cholangioenterostomy
Reoperation
