目的探讨胆管残余和复发结石的原因、特点和处理经验。方法回顾性分析128例胆管残余和复发结石再手术临床资料。 结果残余或复发结石位于肝外胆管68例，肝内胆管48例，肝内、外胆管12例。再手术行残株胆囊切除术2例（1.5%）， 胆总管探查、T管引流术64例（50.0%），肝左外叶切除或肝左叶切除术+胆总管切开取石29例（22.7%），肝右叶、段切除加胆总管切开取石6例（4.7%），同时行狭窄胆管切开整形胆管空肠吻合术13例（10.2%），单独或联合行胆管空肠Roux-en-Y吻合术14例（10.9%）。术后痊愈出院124例，自动出院2例，死亡2例。 术后出现并发症18例（14.1%），其中切口感染 10例，胸腔积液3例，胆肠瘘3例，上消化道出血2例，均经保守治疗治愈。出院的124例中117例获随访1～2年，89例（76.1%）恢复满意，18例（15.4%）恢复较好， 10例（8.5%）经B超、CT、MRCP等检查证实再次复发胆管结石，其中6例经再次手术治愈，4例经中西医结合药物治疗好转。 结论术前全面了解病情，选择合适的手术时机，术中认真仔细的探查确认，并结合术中造影、胆道镜以及术者的经验技术，术后有效的治疗，是降低残石、结石复发及再手术的关键因素。
Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
ObjectiveTo explore risk factors and prognosis of unplanned reoperation in patients with malignant tumors of digestive tract. MethodsThe clinical data of patients with malignant tumors of digestive tract underwent unplanned reoperation who treated in the Department of General Surgery, the Northern District of the Shanghai Ninth People’s Hospital from January 2014 to December 2017 were retrospectively collected, and each operation was matched in a ratio of 1∶3 as a case-conontrol study object. The risk factors and prognosis of unplanned reoperation were analyzed by the basic information, surgical related informations, and postoperative relevant informations. ResultsThere were 33 cases of unplanned reoperation in the 588 patients with malignant tumors of digestive tract treated surgically, 8 cases died after the unplanned reoperation. The analysis results showed that the basic diseases, history of previous abdominal surgery, preoperative anemia, the first operative time >4 h and intraoperative blood loss ≥400 mL were the independent risk factors of the unplanned reoperations (P<0.050); the basic diseases, unplanned preoperative hemoglobin <90 g/L and intraoperative blood loss ≥400 mL were the independent factors of death for patients with unplanned reoperation (P<0.050). ConclusionsEffective intervention on independent risk factors associated with unplanned reoperation in patients with digestive tract malignant tumors can reduce incidence of unplanned reoperation in future and improve prognosis.
目的提高广泛粘连性肠梗阻的治疗效果，预防粘连性肠梗阻复发。方法分析我院1994年1月至2000年5月6年间手术治疗28例广泛粘连性肠梗阻的临床资料。结果手术后无肠梗阻复发，术后8例发生切口感染，无手术死亡及肠瘘发生。结论把握好手术时机是提高粘连性肠梗阻治疗效果的关键，肠排列术是预防粘连性肠梗阻的一个有效方法。
目的探讨胆囊切除术后再次手术的原因及其防治措施。方法对近6年我院收治的胆囊切除术后仍有症状，经B超、ERCP、MRCP、腹部X线平片及十二指肠低张造影等检查发现需再次手术的81例患者的临床资料进行回顾性分析，并结合文献，对其常见原因及其预防治疗措施进行了讨论。结果81例患者根据不同病因予以了相应的手术，如残株胆囊切除术、胆总管切开取石术、十二指肠憩室手术等。再次手术均取得良好效果，无手术死亡。结论对胆囊切除术后仍有症状者应作全面检查，部分患者可找出原因进行相应治疗，能取得良好效果； 而且绝大部分的再次手术，通过术前评估及术中各种技巧的应用是可以防范的。