胆囊床胆管损伤的处理  

Management of Duct Injury in Ballbladder Bed

作　　者：范银亮 

机构地区：[1]河南省商丘市第三人民医院普外科,商丘市476000

出　　处：《医药论坛杂志》2005年第9期14-16,共3页Journal of Medical Forum

摘　　要：目的提高对胆囊床胆管及其损伤的认识和处理对策。方法回顾性分析1993年1月～2002年1月胆囊切除后胆囊床胆管损伤37例的诊治情况。结果37例患者中,证实为Luschka胆管17例、胆囊肝管4例、右前叶肝管及其分支3例;其余13例仅发现胆瘘而未见损伤胆管。本组30例经胆瘘处缝合引流或单纯引流治愈,4例未置引流者因局限性胆汁积聚经皮置管或穿刺引流治愈,另3例因病情恶化而再次剖腹手术。结论胆囊切除时易致胆囊床胆管损伤,术中仔细检查裸露胆囊床有无胆瘘应列为常规步骤,一旦发现有胆瘘,不论对胆漏处如何处理均应放置引流。Objective To explore the causes for the bile duct injury in gallbladder bed and investigate its diagnosis and management.Methods The data of 37 cases of bile duct injury in the gallbladder bed after cholecystectomy between January 1993 to March 2002 were retrospectively anayzed.Results According to the operative records,17 among the 37 cases had leakage from Luschka bile duct,4 from the cholecystohepatic duct and 3 from the right lobular hepatic duct and its bramches.The sources of leakage were not identified in other 13 cases.The injured sites were sutured and drained or drained alone in 30 cases.The other 4 cases without drainage were percutaneously under the ultrasonographic guidance because of an intraabdominal bile collection.The remaining 3 cases were surgically treated again for aggravation of the illness.Conclusion During performance of cholecystectomy,surgeons should pay close attention to the bile duct in the gallbladder bed for its vulnerable position.Careful inspection of the gallbladder bed should be a routine procedure after the operation.Once the bile leakage was recognized in the gallbladder bed,intraoperative drainage must be performed.

关 键 词：胆囊切除术 胆管 胆漏 外科引流 

分 类 号：R657.4[医药卫生—外科学]