本文選題：膽道再次手術　切入點：再次手術的原因及并發(fā)癥　出處：《昆明醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：分析膽道術后再次手術的常見原因,探討術式選擇、總結膽道再次手術經驗及術后并發(fā)癥的預防措施,為臨床工作提供一定的指導和幫助。方法：回顧性分析自2007年1月-2014年12月在我院就診的183例第2次膽道手術病例的臨床資料,并分析我院和昆明醫(yī)科大學第二附屬醫(yī)院就診的102例第3次及以上膽道手術病例的臨床資料,分析總結膽道再次或多次手術的常見原因、術式選擇、術后并發(fā)癥發(fā)生率及隨訪優(yōu)良率。結果：第2次膽道手術的主要原因為結石殘留或復發(fā),占77.6%(142/183),明顯高于第3次及以上膽道手術的患者的27.5%(28/102),兩者比較,差異有統(tǒng)計學意義(X2=68.42,P0.05)。第3次及以上膽道手術的主要原因是膽管良性狹窄,占68.6%(70/102),明顯高于第2次膽道手術的12.5%(23/183),兩者比較,差異有統(tǒng)計學意義(X2=93.63,P0.05)。膽道再次手術285例患者中49例圍手術期發(fā)生并發(fā)癥,其中膽道第2次手術患者的并發(fā)癥發(fā)生率為10.9%(20/183),明顯低于膽道第3次及以上手術患者的28.4%(29/102),兩者比較,差異有統(tǒng)計學意義(X2=14.09,P0.05)。因膽道結石殘留或復發(fā)再次手術主要的手術方式有膽道探查術,膽腸吻合術,肝葉(段)切除術或以上術式聯合使用,其術后效果優(yōu)良率為95.8%。膽管或膽腸吻合口狹窄再次手術主要的手術方式為膽腸吻合術,術后效果優(yōu)良率為91%。結論：1.結石殘留或復發(fā)為第2次膽道手術的主要原因；膽管或膽腸吻合口狹窄是第3次及以上膽道手術的主要原因。2.膽道再次手術并發(fā)癥的發(fā)生率,隨手術次數的增多而增高。3.因結石殘留或復發(fā)行再次手術治療的方式主要有膽總管切開取石+T管引流術、膽腸吻合術及肝葉或肝段切除術；膽管或膽腸吻合口狹窄主要手術方式為膽腸吻合術,其他原因根據病變部位及性質選擇恰當手術。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.4

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相關期刊論文 前1條

1 李玉民;張軍強;;肝門部膽管癌的外科治療[J];中華肝臟外科手術學電子雜志;2014年05期

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本文編號：1587794