中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2012年
5期
422-425
,共4页
赵登秋%周龙翔%汤建燕%熊强%邬叶锋%姜宝飞
趙登鞦%週龍翔%湯建燕%熊彊%鄔葉鋒%薑寶飛
조등추%주룡상%탕건연%웅강%오협봉%강보비
胆道疾病%再次手术%胆道外科手术
膽道疾病%再次手術%膽道外科手術
담도질병%재차수술%담도외과수술
Biliary diseases%Reoperation%Biliary surgical procedures
目的 探讨导致胆道再次或多次手术的原因.方法 回顾性分析2005年1月至2011年6月上海市第六人民医院金山分院收治的265例行胆道再次或多次手术患者的临床资料.第1次胆道再次手术主要以取尽结石、修补胆管损伤、治疗恶性肿瘤为主要目的.手术方式主要包括胆总管切开取石+T管引流术或胆管空肠Roux-en-Y吻合术,经胆道镜或ERCP+ EST取石术,胆总管切开取石+肝段或肝叶切除+T管引流术或胆管空肠Roux-en-Y吻合术,胆管狭窄切开成形+胆肠内引流术,肝外胆管对端吻合+T管支撑引流术,肿瘤根治性或姑息性手术,单纯胆肠内引流术或内镜下置胆道内支架引流术,剖腹探查术,胆瘘或出血部位缝扎、止血、腹腔冲洗和置管引流术等.第2次或多次胆道再次手术以解除胆管狭窄,建立通畅的胆汁引流途径为目的.组间率的比较采用x2检验.结果 胆道第1次再次手术的主要原因为结石残留或复发,占69.8％ (120/172),明显高于胆道第2次或多次再次手术患者的31.2％( 29/93),两者比较,差异有统计学意义(x2 =36.51,P＜0.05).第2次或多次再次手术的主要原因是胆管或胆肠吻合口狭窄,占58.1％ (54/93),明显高于第1次再次手术的4.1％ (7/172),两者比较,差异有统计学意义(x2=99.32,P＜0.05).265例患者中46例围手术期发生并发症,其中第1次胆道再次手术患者的并发症发生率为10.5％(18/172),明显低于第2次或多次胆道再次手术患者的30.1％(28/93),两者比较,差异有统计学意义(x2 =13.61,P＜0.05).围手术期死亡6例,死因为失血性休克或MODS;第1次胆道再次手术患者和第2次或多次胆道再次手术患者的病死率分别为1.7％(3/172)和3.2％( 3/93),两者比较,差异无统计学意义(x2 =0.59,P ＞0.05).结论 导致胆道再次或多次手术的原因包括疾病本身和手术操作.术前对病情充分评估,术中谨慎操作,选择合理的手术方式是降低再次手术及围术期并发症发生率的关键.
目的 探討導緻膽道再次或多次手術的原因.方法 迴顧性分析2005年1月至2011年6月上海市第六人民醫院金山分院收治的265例行膽道再次或多次手術患者的臨床資料.第1次膽道再次手術主要以取儘結石、脩補膽管損傷、治療噁性腫瘤為主要目的.手術方式主要包括膽總管切開取石+T管引流術或膽管空腸Roux-en-Y吻閤術,經膽道鏡或ERCP+ EST取石術,膽總管切開取石+肝段或肝葉切除+T管引流術或膽管空腸Roux-en-Y吻閤術,膽管狹窄切開成形+膽腸內引流術,肝外膽管對耑吻閤+T管支撐引流術,腫瘤根治性或姑息性手術,單純膽腸內引流術或內鏡下置膽道內支架引流術,剖腹探查術,膽瘺或齣血部位縫扎、止血、腹腔遲洗和置管引流術等.第2次或多次膽道再次手術以解除膽管狹窄,建立通暢的膽汁引流途徑為目的.組間率的比較採用x2檢驗.結果 膽道第1次再次手術的主要原因為結石殘留或複髮,佔69.8％ (120/172),明顯高于膽道第2次或多次再次手術患者的31.2％( 29/93),兩者比較,差異有統計學意義(x2 =36.51,P＜0.05).第2次或多次再次手術的主要原因是膽管或膽腸吻閤口狹窄,佔58.1％ (54/93),明顯高于第1次再次手術的4.1％ (7/172),兩者比較,差異有統計學意義(x2=99.32,P＜0.05).265例患者中46例圍手術期髮生併髮癥,其中第1次膽道再次手術患者的併髮癥髮生率為10.5％(18/172),明顯低于第2次或多次膽道再次手術患者的30.1％(28/93),兩者比較,差異有統計學意義(x2 =13.61,P＜0.05).圍手術期死亡6例,死因為失血性休剋或MODS;第1次膽道再次手術患者和第2次或多次膽道再次手術患者的病死率分彆為1.7％(3/172)和3.2％( 3/93),兩者比較,差異無統計學意義(x2 =0.59,P ＞0.05).結論 導緻膽道再次或多次手術的原因包括疾病本身和手術操作.術前對病情充分評估,術中謹慎操作,選擇閤理的手術方式是降低再次手術及圍術期併髮癥髮生率的關鍵.
목적 탐토도치담도재차혹다차수술적원인.방법 회고성분석2005년1월지2011년6월상해시제륙인민의원금산분원수치적265례행담도재차혹다차수술환자적림상자료.제1차담도재차수술주요이취진결석、수보담관손상、치료악성종류위주요목적.수술방식주요포괄담총관절개취석+T관인류술혹담관공장Roux-en-Y문합술,경담도경혹ERCP+ EST취석술,담총관절개취석+간단혹간협절제+T관인류술혹담관공장Roux-en-Y문합술,담관협착절개성형+담장내인류술,간외담관대단문합+T관지탱인류술,종류근치성혹고식성수술,단순담장내인류술혹내경하치담도내지가인류술,부복탐사술,담루혹출혈부위봉찰、지혈、복강충세화치관인류술등.제2차혹다차담도재차수술이해제담관협착,건립통창적담즙인류도경위목적.조간솔적비교채용x2검험.결과 담도제1차재차수술적주요원인위결석잔류혹복발,점69.8％ (120/172),명현고우담도제2차혹다차재차수술환자적31.2％( 29/93),량자비교,차이유통계학의의(x2 =36.51,P＜0.05).제2차혹다차재차수술적주요원인시담관혹담장문합구협착,점58.1％ (54/93),명현고우제1차재차수술적4.1％ (7/172),량자비교,차이유통계학의의(x2=99.32,P＜0.05).265례환자중46례위수술기발생병발증,기중제1차담도재차수술환자적병발증발생솔위10.5％(18/172),명현저우제2차혹다차담도재차수술환자적30.1％(28/93),량자비교,차이유통계학의의(x2 =13.61,P＜0.05).위수술기사망6례,사인위실혈성휴극혹MODS;제1차담도재차수술환자화제2차혹다차담도재차수술환자적병사솔분별위1.7％(3/172)화3.2％( 3/93),량자비교,차이무통계학의의(x2 =0.59,P ＞0.05).결론 도치담도재차혹다차수술적원인포괄질병본신화수술조작.술전대병정충분평고,술중근신조작,선택합리적수술방식시강저재차수술급위술기병발증발생솔적관건.
Objective To investigate the causes of repeated operations in patients with biliary diseases.Methods The clinical data of 265 patients who received repeated operations at the Jinshan Branch of Shanghai Sixth People's Hospital from January 2005 to June 2011 were retrospectively analyzed.The causes of repeated operations were analyzed. The first reoperation aimed at removing the calculi completely,repairing the injured biliary ducts and managing malignant tumors. The primary surgical procesures of the first reoperation included choledochotomy + T tube drainage,choledochotomy + Roux-en-Y choledochojejunostomy,endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy,choledochotomy + hepatectomy + T tube drainage or Rouxen-Y choledochojejunostomy,choledochotomy + biliary-endo-drainage,end-to-end anastomosis of bile duct + T tube drainage,radical or palliative resection of tumor,endoscopic biliary stent drainage or exploratory laparotomy.The second and multiple reoperations aimed at reconstructing the passage for biliary drainage. All data were analyzed using the chi-square test.Results A total of 69.8％ (120/172) of patients who had recurrent or retained calculi received first reoperation,which was significantly higher than 31.2％ ( 29/93 ) of those who received second or multiple reoperations (x2 =36.51,P ＜ 0.05 ).A total of 58.1％ (54/93) of patients who had benign stenosis of bilioenteric anastomosis received multiple reoperations,which was significantly higher than 4.1％ (7/172) than those who received first reoperation (x2 ＝ 99.32,P ＜ 0.05 ).Of the 265 patients,46 had complications.The incidence of complications of patients who receive first reoperation was 10.5％ ( 18/172),which was significantly lower than 30.1％ (28/93) of patients who received second or multiple reoperations ( x2 =13.61,P ＜ 0.05 ).Six patients died of hemorrhagic shock or multiple organ syndrome dysfunction postoperatively.The mortality rates for patients who received first reoperation and second or multiple reoperations were 1.7％(3/172) and 3.2％ (3/93),respectively,with no significant difference ( x2 ＝ 0.59,P ＞ 0.05 ).Conclusions The causes for reoperation of biliary disease are muhifactorial.Full assessment of the status of biliary diseases and ample preperation preoperatively,careful operation and precise and rational selection of operative procedures are keys to decrease the reoperative rates and perioperative complications.
