肝胆结石术后再次手术的原因分析及防治对策
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摘要
目的针对经肝胆结石术后还需要再次进行手术的患者对其原因展开探讨,并分析其防治对策。方法在2015年2月至2017年4月选择我院进行肝胆结石手术之后需要进行再次手术的患者30例,对其展开再次手术之前进行原因分析,并采取针对性探讨,分析防治对策。结果患结石类型不同的患者进行再次手术原因:本研究患者结石类型包括肝内胆管结石和胆总管结石,其需要进行再次手术都包括腹腔感染、出血、损伤等,并且类型出现以上情况的差别不大,但其中腹腔感染占有十分重要的比重;患结石类型不同的患者进行再次手术出现并发症的情况:结石类型为肝内胆管结石的患者有18例,进行再次手术之后,出现并发症及其例数分别为切口感染1例、胆管炎2例、胆漏1例,总数占比22.2%;结石类型为胆总管结石的患者,进行再次手术后,出现并发症及其例数分别为切口感染1例,占比8.3%,结石类型比较χ2=7.508,P=0.006,存在明显差别,肝内胆管结石的患者出现并发症的数量更多。结论需要进行再次手术的肝胆结石患者主要是因为出现腹腔感染,因此需要做好手术制定及规范的操作,才能降低再次手术的几率。
Objective To investigate the reasons why patients who need surgery again after liver and gallstones surgery and to analyze their prevention and treatment measures. Methods From February 2015 to April 2017, 30 patients who need re operation after hepatobiliary operation were selected. The reasons for their reoperation were analyzed. Results Patients with different types of stones were reoperated. Reasons for this procedure include: Intrahepatic bile duct stones and choledocholithiasis in this study, which require reoperation including abdominal infection, bleeding, injury and so on. The situation is not very different, but the proportion of abdominal infection occupy a very important; suffering from stones of different types of patients undergoing reoperation complications: 18 cases of stones in patients with intrahepatic bile duct stones, reoperation. After complications, there were 1 cases of incision infection, 2 cases of cholangitis, 1 case of bile leakage, the total number accounted for 22.2%; patients with stone type choledocholithiasis, reoperation,complications and the number of cases were incision infection in 1 case, accounting for 8.3%, comparison of stone types χ2=7.508,P=0.006, there are significant differences in patients with intrahepatic bile duct stones more complications. Conclusion The patients with liver and gallstones who need reoperation are mainly due to abdominal infection. Therefore, it is necessary to make the operation setting and standard operation in order to reduce the chance of reoperation.
Objective To investigate the reasons why patients who need surgery again after liver and gallstones surgery and to analyze their prevention and treatment measures. Methods From February 2015 to April 2017, 30 patients who need re operation after hepatobiliary operation were selected. The reasons for their reoperation were analyzed. Results Patients with different types of stones were reoperated. Reasons for this procedure include: Intrahepatic bile duct stones and choledocholithiasis in this study, which require reoperation including abdominal infection, bleeding, injury and so on. The situation is not very different, but the proportion of abdominal infection occupy a very important; suffering from stones of different types of patients undergoing reoperation complications: 18 cases of stones in patients with intrahepatic bile duct stones, reoperation. After complications, there were 1 cases of incision infection, 2 cases of cholangitis, 1 case of bile leakage, the total number accounted for 22.2%; patients with stone type choledocholithiasis, reoperation,complications and the number of cases were incision infection in 1 case, accounting for 8.3%, comparison of stone types χ2=7.508,P=0.006, there are significant differences in patients with intrahepatic bile duct stones more complications. Conclusion The patients with liver and gallstones who need reoperation are mainly due to abdominal infection. Therefore, it is necessary to make the operation setting and standard operation in order to reduce the chance of reoperation.
引文
[1]康欣,杨兴建,徐茂林,等.117例肝胆结石术后再次手术的原因分析及防治对策[J].中国医药指南,2013,45(17):409-410.
[2]曾鹏.145例肝胆结石术后再次手术的原因分析及预防对策[J].中国医药指南,2013,34(18):434-435.
[3]王彬.肝胆结石术后再次手术的原因分析及防治措施的分析[J].特别健康:下,2014,53(9):21-22.
[4]高峰,马树民,薛峰,等.肝内外胆管结石术后再次手术的原因分析及防治对策[J].中国基层医药,2014,45(21):72.
[5]彭剑波,李永国.肝胆管结石择期手术后再手术原因分析与治疗对策[J].医学临床研究,2006,23(10):1682-1683.
[6]张鸣华.肝外胆管结石术后再次手术的原因分析及防治对策[J].临床医药文献电子杂志,2017,4(30):68.
[7]陈志宁.肝胆管结石择期手术后再手术原因分析与治疗对策[J].健康之路,2014,23(2):141.
[8]赵万胜,桂武斌,蔡瑞福,等.胆道术后肝外胆管结石的手术体会[J].中国医药指南,2014,34(13):25-27.
[9]周飞国,刘才峰,黄亮,等.多处肝切除治疗复杂肝胆管结石病的并发症分析及防治[J].肝胆胰外科杂志,2009,21(2):110-112.
[10]罗新萍,周生智,黄建平.腰硬联合阻滞下罗哌卡因复合舒芬太尼用于潜伏期分娩镇痛的效果观察[J].当代医学,2017,23(28):17.
[11]马宏青,程文,高建平,等.4例腔镜下钬激光治疗上尿路结石手术失败原因分析及其预防措施[J].医学研究生学报,2010,23(8):852-855.
[12]何松狮,吴洪伟.肝胆外科手术后38例胆漏的原因分析及防治[J].中国实用医药,2013,8(23):117-118.
[13]刘堂明.肝胆外科患者术后胆漏的原因分析及临床防治措施分析[J].大家健康旬刊,2015,45(2):72.
[14]刘丽波,付京.肝胆外科手术后胆漏的原因分析及防治对策[J].白求恩医学杂志,2014,12(2):163-164.
[15]马陆军.肝胆手术后切口感染原因分析及防治对策分析[J].临床医药文献杂志:电子版,2016,3(16):3182-3183.
[2]曾鹏.145例肝胆结石术后再次手术的原因分析及预防对策[J].中国医药指南,2013,34(18):434-435.
[3]王彬.肝胆结石术后再次手术的原因分析及防治措施的分析[J].特别健康:下,2014,53(9):21-22.
[4]高峰,马树民,薛峰,等.肝内外胆管结石术后再次手术的原因分析及防治对策[J].中国基层医药,2014,45(21):72.
[5]彭剑波,李永国.肝胆管结石择期手术后再手术原因分析与治疗对策[J].医学临床研究,2006,23(10):1682-1683.
[6]张鸣华.肝外胆管结石术后再次手术的原因分析及防治对策[J].临床医药文献电子杂志,2017,4(30):68.
[7]陈志宁.肝胆管结石择期手术后再手术原因分析与治疗对策[J].健康之路,2014,23(2):141.
[8]赵万胜,桂武斌,蔡瑞福,等.胆道术后肝外胆管结石的手术体会[J].中国医药指南,2014,34(13):25-27.
[9]周飞国,刘才峰,黄亮,等.多处肝切除治疗复杂肝胆管结石病的并发症分析及防治[J].肝胆胰外科杂志,2009,21(2):110-112.
[10]罗新萍,周生智,黄建平.腰硬联合阻滞下罗哌卡因复合舒芬太尼用于潜伏期分娩镇痛的效果观察[J].当代医学,2017,23(28):17.
[11]马宏青,程文,高建平,等.4例腔镜下钬激光治疗上尿路结石手术失败原因分析及其预防措施[J].医学研究生学报,2010,23(8):852-855.
[12]何松狮,吴洪伟.肝胆外科手术后38例胆漏的原因分析及防治[J].中国实用医药,2013,8(23):117-118.
[13]刘堂明.肝胆外科患者术后胆漏的原因分析及临床防治措施分析[J].大家健康旬刊,2015,45(2):72.
[14]刘丽波,付京.肝胆外科手术后胆漏的原因分析及防治对策[J].白求恩医学杂志,2014,12(2):163-164.
[15]马陆军.肝胆手术后切口感染原因分析及防治对策分析[J].临床医药文献杂志:电子版,2016,3(16):3182-3183.