Clinical Analysis Of Recurrent Reoperation Of Intrahepatic And Extrahepatic Bile Duct Stones

Objective: Study on the causes of reoperation in patients with recurrent intrahepatic and extrahepatic bile duct stones.And to explore the therapeutic effect of different surgical methods on recurrent calculus.To provide a reference for clinical individualized choice of surgical methods.Methods: Retrospective analysis the clinical data and surgical treatment methods of 64 patients with recurrent intrahepatic and extrahepatic bile duct stones in our hospital from January 2015 to December 2016.Surgical treatment should follow the principle of removing stones,removing stenosis and obstruction,removing lesions,unobstructing drainage and preventing recurrence.According to the different surgical methods,it was divided into a single operation group(34 cases)and a combined operation group(30 cases).The single operation included choledochotomy for stone removal with T-tube drainage,Roux-en-Y choledochojejunostomy,hepatic lobectomy or segmental hepatectomy,incision of anastomotic stoma and removal of stones.The surgical method of combined operation group is a combination of several single operations.Analyze the causes of reoperation in all patients.The operation time,intraoperative bleeding volume,length of stay,Hospitalization expenses,the residual rate of stone after operation,postoperative short-term complications(including infection of incisional wound,Bile leakage,abdominal infection,pneumonia and pleural effussion,etc)were compared between the two groups.And to evaluate the curative effect according to the recurrence rate of stone after 1 year follow up.The measurement data were expressed by mean ±standard deviation(`x ±s)and compared with t test(P < 0.05),and the count data were compared by X2 test(P < 0.05).P < 0.05 means the difference have statistical significance.Results: All patients were completed the operation successfully and discharged smoothly.There was no statistical significance in sex,age,preoperative complication,preoperative liver function classification,preoperative methods and distribution of calculi in intrahepatic and extrahepatic bile ducts between the two groups(P>0.05).It has comparability.In single operation group,the operation time was(3.3 + 1.3)hours,intraoperative bleeding were(105.6 + 93.1)ml,the length of stays were(17.9 + 9.9)days,the hospitalization expense was(32350.4 + 11931.1)Yuan,postoperative incision infection occurred in 3 patients.8 patients developed pneumonia and pleural effusion.A case of bile leakage.The total complication rate was 35.29%.In combined operation group,the operation time was(3.9 + 1.4)hours,intraoperative bleeding were(210.7.6 + 215.4)ml,the length of stays were(21.8±8.9)days,the hospitalization expense was(41107.1±15249.9)Yuan,Postoperative incision infection occurred in 3 patients.8 patients developed pneumonia and pleural effusion.A case of bile leakage.Four patients with multiple complications at the same time.One case each occurred abdominal infection and gastrointestinal hemorrhage with duodenal fistula.The total complication rate was 43.33%.There was no statistical significance in Average operation time and average length of stay between the two groups(P>0.05).The average bleeding volume and the average hospitalization expense in single group were lower than those in the combined group,and the difference was statistically significant(P < 0.05).The residual rate and recurrence rate in the single group were 47.06% and 33.33 %.The rate in the combined operation group were 13.33% and 7.69%.They were lower than the single operation group.The difference was statistically significant(P < 0.05).Conclusion: The main reason for reoperation in patients with recurrent intrahepatic and extrahepatic bile duct stones is residual and recurrence of calculi.Lack of awareness and judgment of Oddi sphincter function before and during operation,improper choice of operation mode,biliary stricture and postoperative anastomotic stenosis can lead to residual and recurrence of stones.Combined with the long-term stimulation of stones and cholangitis,it is easy to cause bile duct cancer.These are the causes of bile duct reoperation.The recurrence of intrahepatic and extrahepatic cholelithiasis mainly depends on surgical reoperation.Relevant examination should be improved before operation.Analyze and discuss the clinical data of the patients and the related situation of pre-operation.Then combined with the patient's actual condition and medical condition to choose reasonable operation method.Strictly control the indications and contraindications of the operation.Operate careful and standardized during operation.Unobstructing drainage at the end of operation.And symptomatic treatment after operation.The results showed that although the combined operation was complicated,bleeding was more,and the cost of operation and hospitalization was higher,it could effectively relieve the biliary stricture problem while removing the diseased liver and unobstructed the drainage of bile.The residual and recurrent stones were less common after operation.So it is suggested that little of minor stones was limited to one side of intrahepatic or extrahepatic should choose a single operation method.It is suggested that lots of lager stones was scattered throughout intrahepatic or extrahepatic should choose the combined operation method.Remove the lesion and solve the biliary obstruction problem completely.It can effectively increase the clearance rate and reduce the recurrence rate of stones.Improve the patients' symptoms and quality of life.