Background. The surgical treatment of primary intrahepatic bile duct stones is associated with high rates of postoperative complications, stone recurrence, and reoperation. This study aimed to report an 11-year experience in the management of postoperative recurrence of intrahepatic bile duct stones, analyze the causes of the reoperation, and establish appropriate surgical procedures. Materials and Methods. The records of 148 patients with postoperative recurrence of primary intrahepatic bile duct stones treated from January 2005 to December 2015 were retrospectively reviewed. Prior surgical treatment and postoperative data were analyzed to investigate possible causes of recurrence and reoperation. Results. All patients with a prior cholangiojejunostomy (n = 61) developed biliary stenosis (100%). Of the 86 patients without cholangiojejunostomy, 71 (82.56%) had abnormalities in the structure and function of the lower end of the common bile duct, and 86 had hilar and intrahepatic bile duct stenosis. Of all 148 patients, 136 (91.89%) had positive intraoperative bile cultures. Patients were treated with a modified surgical procedure, and the combined excellent and good rate of long-term outcomes reached 85.48% (106/124). The stone recurrence rate of the 124 patients decreased from 100% (124/124) of the prior operation to 5.65% (7/124) during the reoperation. Conclusions. The pathogenesis of primary intrahepatic bile duct stones is associated with biliary infection and intrahepatic bile duct cholestasis. According to the etiology and pathogenic mechanism, surgical procedures that improve long-term outcomes and reduce postoperative recurrence include bile duct exploration with stone extraction, partial hepatectomy, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy.

中文翻译：

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原发性肝内胆管结石复发的手术治疗

背景。原发性肝内胆管结石的手术治疗与术后并发症、结石复发和再次手术的高发生率相关。本研究旨在报告11年肝内胆管结石术后复发的处理经验，分析再次手术的原因，并制定合适的手术方案。材料和方法。回顾性分析2005年1月至2015年12月收治的148例原发性肝内胆管结石术后复发患者的资料。分析先前的手术治疗和术后数据，以调查复发和再次手术的可能原因。结果。所有接受过胆管空肠吻合术的患者（n = 61) 出现胆道狭窄 (100%)。未行胆管空肠吻合术的86例患者中，71例（82.56%）存在胆总管下端结构和功能异常，86例存在肝门部和肝内胆管狭窄。在所有 148 名患者中，136 名 (91.89%) 术中胆汁培养呈阳性。患者采用改良手术方式治疗，远期疗效综合优良率达85.48%（106/124）。124例患者结石复发率由术前的100%（124/124）下降至再次手术时的5.65%（7/124）。结论. 原发性肝内胆管结石的发病机制与胆道感染和肝内胆管胆汁淤积有关。根据病因和致病机制，改善远期疗效和减少术后复发的外科手术包括取石胆管探查术、部分肝切除术、肝门导管成形术和 Roux-en-Y 肝空肠吻合术。