中国实用外科杂志

中国实用外科杂志 ›› 2012, Vol. 32 ›› Issue (01): 57-59.

• 专家论坛 • 上一篇    下一篇

肝胆管结石病多次手术原因及决策

陈亚进   

  1. 中山大学孙逸仙纪念医院肝胆胰外科，广东广州 510120
  • 出版日期:2012-01-01 发布日期:2011-12-29

  • Online:2012-01-01 Published:2011-12-29

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摘要：

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。

关键词: 肝胆管结石, 结石再发, 再次手术, 肝叶/段切除

Abstract:

The cause of Hepatolithiasis reoperation and treatment decisions        CHEN Ya-jin. Division of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou510120, China
Abstract    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.

Key words: hepatolithiasis, stone recurrence, reoperation, segmental hepatectomy