目的　探讨 7例再次剖腹手术行壶腹部癌根治性切除的病人在第一次手术时未行根治性切除的原因。方法　结合术后随访 ,详细回顾病例资料。结果　第一次剖腹手术时认为癌肿不能切除 3例 ,漏诊 3例 ,误诊 1例 ;第二次手术前结合内镜逆行胰胆管造影 (ERCP)、CT等检查 ,均明确诊断为壶腹部癌 ,其中CT显示壶腹部占位 5例 ,均未见胰外转移及血管侵犯。均再次剖腹施行胰十二指肠切除术。结论　胆道远端恶性梗阻病人术前ERCP、CT等影像学诊断极为重要 ,有助于明确诊断 ,减少手术盲目性 ,避免再次手术。 Objective To investigate the causes of radical resection in the first surgery of 7 cases undergoing resection of ampulla after curative resection. Methods combined with postoperative follow-up, a detailed review of case information. Results In the first laparotomy, 3 cases were considered unresectable, 3 cases were misdiagnosed, and 1 case was misdiagnosed. The second operation combined with endoscopic retrograde cholangiopancreatography (ERCP) and CT showed definite diagnosis of ampullary carcinoma , CT showed ampulla of 5 cases, no extra-pancreatic metastasis and vascular invasion. Re-laparotomy pancreatoduodenectomy. Conclusion Preoperative imaging of ERCP, CT and other malignant obstruction in patients with distal bile duct obstruction is very important, which helps to confirm the diagnosis, reduce the operation blindness and avoid the reoperation.