胆道再次手术的常见原因、并发症及术式选择的探讨分析

发布时间：2018-03-09 08:39

本文选题：胆道再次手术　切入点：再次手术的原因及并发症　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：分析胆道术后再次手术的常见原因,探讨术式选择、总结胆道再次手术经验及术后并发症的预防措施,为临床工作提供一定的指导和帮助。方法：回顾性分析自2007年1月-2014年12月在我院就诊的183例第2次胆道手术病例的临床资料,并分析我院和昆明医科大学第二附属医院就诊的102例第3次及以上胆道手术病例的临床资料,分析总结胆道再次或多次手术的常见原因、术式选择、术后并发症发生率及随访优良率。结果：第2次胆道手术的主要原因为结石残留或复发,占77.6%(142/183),明显高于第3次及以上胆道手术的患者的27.5%(28/102),两者比较,差异有统计学意义(X2=68.42,P0.05)。第3次及以上胆道手术的主要原因是胆管良性狭窄,占68.6%(70/102),明显高于第2次胆道手术的12.5%(23/183),两者比较,差异有统计学意义(X2=93.63,P0.05)。胆道再次手术285例患者中49例围手术期发生并发症,其中胆道第2次手术患者的并发症发生率为10.9%(20/183),明显低于胆道第3次及以上手术患者的28.4%(29/102),两者比较,差异有统计学意义(X2=14.09,P0.05)。因胆道结石残留或复发再次手术主要的手术方式有胆道探查术,胆肠吻合术,肝叶(段)切除术或以上术式联合使用,其术后效果优良率为95.8%。胆管或胆肠吻合口狭窄再次手术主要的手术方式为胆肠吻合术,术后效果优良率为91%。结论：1.结石残留或复发为第2次胆道手术的主要原因；胆管或胆肠吻合口狭窄是第3次及以上胆道手术的主要原因。2.胆道再次手术并发症的发生率,随手术次数的增多而增高。3.因结石残留或复发行再次手术治疗的方式主要有胆总管切开取石+T管引流术、胆肠吻合术及肝叶或肝段切除术；胆管或胆肠吻合口狭窄主要手术方式为胆肠吻合术,其他原因根据病变部位及性质选择恰当手术。
[Abstract]:Objective: to analyze the common causes of re-operation after biliary tract operation, to explore the choice of operation methods, to summarize the experience of re-operation of biliary tract and the preventive measures of postoperative complications. Methods: the clinical data of 183 cases of the second biliary tract operation from January 2007 to December 2014 were analyzed retrospectively. The clinical data of 102 cases of biliary tract surgery in our hospital and the second affiliated Hospital of Kunming Medical University were analyzed and summarized. Results: the main cause of the second biliary tract operation was residual or recurrent stones, accounting for 77.6% 14.2% of 183%, which was significantly higher than that of the patients with the third or more biliary tract operation (27.5T / 102g). The main cause of the third and higher biliary tract surgery was benign stricture of the bile duct, accounting for 68.6% of 70 / 102, which was significantly higher than that of the second choledochal operation (12.5m / 183). The difference was statistically significant (P 0.05). Among 285 patients undergoing biliary re-operation, 49 had perioperative complications. The incidence of complications in the second operation of biliary tract was 10.9% 20 / 183%, which was significantly lower than that in the patients with the third or more biliary tract operation (28.44% 29 / 102). The difference was statistically significant (P 0.05). The main methods of reoperation due to residual or recurrent biliary calculi were biliary exploration, choledochojejunostomy, hepatectomy or combined use. The excellent and good rate of operation was 95.8%. The main operation mode of bile duct or choledochojejunostomy was choledochojejunostomy, and the excellent and good rate was 91.Conclusion: 1. Residual or recurrence of stones is the main cause of the second biliary tract operation. Stricture of bile duct or choledochojejunostomy was the main cause of the third and higher biliary tract operation. With the increase of the number of operations, the main methods of reoperation were choledocholithotomy, choledocholithiasis, choledochojejunostomy and hepatectomy. Choledochojejunostomy is the main operative method for bile duct or cholangiojejunostomy stenosis.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

【参考文献】