胆道术后肝外胆管结石的手术体会

摘要

Objective To summarize the possible reasons for extrahepatic bile duct stones after biliary tract surgical operation and experience on reoperation. Methods The clinical data of 69 cases patients from January 2003 to January 2013 with postoperative extrahepatic bile duct stones were analyzed retrospectively, and were discussed combining with related literatures at home and abroad. Results 69 cases were all completed surgery successfully; side injury occurred in 1 case, incision infection or fat liquefaction occurred in 6 cases, died after leaving hospital without cure in 1 case;retained stones in common bile duct in 7 cases. Conclusion There are many reasons for postoperative extrahepatic bile duct stones: postoperative retained stones, gallstone, hepatolithiasis detachment, or recurrence of stones and so on; its treatment is mainly operative treatment of open choledocholithotomy, ttube drainage and bilioenteric anastomosis; the keys for treating postoperative extrahepatic bile duct stones are making good preparations and choosing the right operation method before operation, and finding common bile duct correctly and avoiding accidentally injure during operation.%目的：总结胆道外科手术后肝外胆管结石的可能原因，及再次手术处理的体会。方法回顾性分析2003年1月至2013年1月我科收治的69例胆道术后肝外胆管结石的临床资料，并结合国内外相关文献进行探讨。结果69例均顺利完成手术；发生副损伤1例，切口感染或脂肪液化6例，1例自动出院后死亡；7例胆总管残留结石。结论胆道术后肝外胆管结石的原因有术后残留结石、胆囊结石或肝内胆管结石脱落、再发结石等；其治疗主要为以胆总管切开取石+T 管引流及胆肠吻合为主的手术治疗；术前充分准备，选择合适的手术方式，术中正确寻找胆总管、避免误伤是治疗胆道术后肝外胆管结石的关键。