胆道再次手术的原因与对策

Causes and counter measures of reoperation for biliary diseases

  • 摘要: 胆道再次手术是指胆道手术后因为并发症、原有 疾病未治愈或者再次复发而施行的手术,不包括其 他腹部手术后再次针对胆道疾病所施行的手术1 。 胆道再次手术往往为非计划性手术,即再次手术并 非第1次手术时预先安排的,而是由于第 1次手术 时术者对疾病的认知不足,或选择的手术方式不当,或因为发生并发症而被迫进行的再次手术。再次手 术不仅给患者带来额外的创伤和经济、心理上的负 担,而且手术的危险性和并发症的发生率都可能比 第1次手术高得多。

     

    Abstract:

    The reoperation for biliary diseases is usually unplanned, and the major reasons leading to this situation include: (1) The initial operation was performed under emergency situation and radical procedure could not be carried out. (2) The surgical procedure was inadequate. (3) The operator was unqualified for the operation. In order to avoid repeated operations, the following principles must be obeyed strictly. Firstly, once the initial operation was failed, the patients must be transferred to large medical center and the reoperation must be performed by hepatobiliary specialists. Secondly, the operator must realize that most of the patients were in poor condition because of the previous operation, and they needed careful evaluation of organ function and adequate supportive treatment before reoperation. Thirdly, various measures must be taken to avoid unplanned operation and ensure the successful implement of radical operation at a time: (1) Operator must learn all the details of previous operation, which include operation procedure, findings during operation and postoperative complications. (2) Cholangiogram of the whole biliary tree is important for surgical planning, ultrasonography, computed tomography (CT), endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, percutaneous transhepatic cholangiography (PTC), or PTC CT should be performed solely or comprehensively to determine the nature and location of lesions. For bile duct injury, additional examination including CT angiography, magnetic resonance angiography or digital subtraction angiography is necessary to ascertain the accompanied vessel injury. (3) Making individual surgical procedure according to patien′s condition and distribution of lesions.

     

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