关键词: 胆石症, 部分肝叶切除术, 胆总管切开取石术, 胆总管切开探查术, 胆管空肠吻合术, 生活质量

Abstract: Objective To investigate the reasons and prognosis of repeated operations in patients with intra- and extrahepatic cholangiolithiasis. Methods 100 patients with cholangiolithiasis between January 2010 and January 2015 were recruited in this study. The causes of reoperation,options of operations and the quality of life were analyzed. Results 100 patients received reoperation for residual and/or recurrent stones,and 9 were found with concurrent primary biliary enteric anastomotic stenosis,7 with cholangiocarcinoma,and 3 with gastrointestinal stromal tumor and invasion of intrahepatic bile duct;the operation mainly included hepatectomy in 29（29%）,hepatectomy and choledocholithotomy in 24（24%）,choledochoscopic exploratoin and cholangiojejunostomy in 14（14%）;the immediate stone clearance rate was 63%,and the final stone clearance rate was 88%;postoperative incision infection occurred in 19 patients,biliary fistula in 10 patients,pleural effusion in 9 patients,and postoperative biliary tract hemorrhage in 7 patients;75 patients were bile culture positive,and the bacteria were Escherichia Coli（35%）,Pseudomonas aeruginosa （28%）,Klebsiella pneumoniae （19%） and Enterobacter cloacae（18%）;the postoperative hospital stay was （22.7±6.1） d;at 3 and 4 months after operation,2 patients died of secondary tumor and 19 lost;at the end of six months after operation,the physiological function,body pain,general health,role emotional and mental health scores in 79 patients were 92.8±11.6,30.1±9, 87.1±9,98±6.3,81.2±6.7,much improved as compared to those before operation（P<0.05）. Conclusions The main causes of repeated operations were residual stones and recurrence of stones,and surgeons should find more practical and scientific approaches for the radical clearance of stones.

Key words: Cholangiolithiasis, Hepatectomy, Choledocholithotomy, Choledochoscopic exploratoin, Cholangiojejunostomy, Quality of life