胆道手术后胆漏的原因分析及治疗(附28例报告)  

Causes and treatment of biliary fistula after bile duct surgery:report of 28 cases.

作　　者：席广君[1] 阎峻[1] 周海荣[1] 陈静辉[1] 高伟[1] 管益国[1] 

机构地区：[1]浙江省平湖市中医院外科,314200

出　　处：《中国实用外科杂志》2005年第3期162-163,共2页Chinese Journal of Practical Surgery

摘　　要：目的探讨胆道手术后发生胆漏的原因及其预防与治疗方法. 方法对浙江省平湖市中医院1994～2003年间胆道术后发生胆漏的28例临床资料作回顾性分析.结果术后发生胆漏的原因为肝床毛细胆管或细小副肝管损伤15例,胆总管癌切开探查后胆漏1例,胆囊管残端漏1例,T管早期滑脱或拔T管后胆漏10例,T管引流术后护理不当1例.保守治疗21例(75%),再手术7例(25%),除1例胆管癌晚期自动出院外其余均痊愈出院.结论胆漏多发生于胆囊切除术、胆道手术及拔T管后,主要原因与肝床毛细胆管或细小副肝管损伤、局部炎症和操作不当等有关.胆漏发生后应根据腹膜炎的轻重,有无胆道梗阻以及腹腔引流是否通畅等选择保守治疗或再手术治疗.Objective To investigate the cause,prevention and treatment of biliary fistual after biliary tract surgery.Methods The clinical data of 28 patients with biliary fistula a fter bile duct surgery at Pinghu Traditional Chinese Medicine from 1994 to 2003 were reviewed. Results Cause of biliary fistula included injury of liver bed cholangioles or tiny accessory hepatic duct in 15 cases,biliary fistula after in cision and exploration of common bile duct in biliary duct cancer in 1,stump lea kage of cystic duct in 1,early T-tube inadvertent sliding off or after T-tube removement in 10.Twenty-one patients underwent conservative therapy (75%) and 7 reoperation (25%).Fistula was cured in 27 cases,while the remaining one who su ffered from late staged bile duct cancer died.Conclusion Biliary fistula often occurs after cholecystectomy o r bile duct surgery,and after the removal of T-tube.Conservative therapy is oft en successful unless there is a frank peritonitis,biliary tract obstruction or i mproper peritoneal drainage.

关 键 词：术后胆漏 胆道手术 保守治疗 拔T管 副肝管 胆管 损伤 结论 浙江 目的 

分 类 号：R657.4[医药卫生—外科学] R735.8[医药卫生—临床医学]