鼻胆管引流治疗胆囊切除术后胆漏  

Treatment of Postcholecystectomy Bile Leakage by Endoscopic Nasobiliary Drainage

作　　者：高卫东[1] 姚礼庆[1] 何国杰[1] 周平红[1] 徐美东[1] 钟芸诗[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国临床医学》2007年第5期647-648,共2页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨经内镜逆行胰胆管造影(ERCP)和经内镜鼻胆管引流(ENBD)在胆囊切除术后胆漏诊治中的应用价值。方法:对胆囊切除术后有腹痛、发热、B超引导穿刺引流出胆汁而诊断为胆漏的患者进行ERCP检查,并行ENBD。结果:15例患者ERCP检查均成功,10例发现有造影剂漏出,其中2例伴有明显胆管损伤,2例合并有胆总管结石。除2例胆管损伤患者接受手术治疗外,其余13例均经ENBD治疗成功,2例胆总管结石患者成功接受了EST网篮取石术。结论:对于胆囊切除术后出现胆漏的患者,ERCP是理想的诊断方法,而且还可以通过ENBD结合腹腔引流得到有效治疗。Objective：To study the efficacy of endoscopic retrograde cholangiopan creato graphy（ERCP） and endoscopic nasobiliary drainage（ENBD） in the diagnosis and therapy of bile leakage after cholecysteetomy. Methods： ERCP and ENBD were performed in all the patients who had abdominal pain and fever or percutaneous drainage of bile under ultrasound guidance after cholecystectomy. Results： ERCP and ENBD were successful in all the 15 patients. The presence of bile leaks was confirmed by ERCP in 10 patients, major ductal injury in 2 patients, residual stones in 2 patients. Bile leakage was treated successfully in 13 patients with no further complications and 2 patients were treated surgically because of major ductal injury. Residual stones were seen in the common bile duct in 2 patients, sphincterotomy was followed by stone extraction using dormia basket. Conclusion： ERCP is recommended as a safe and efficacious intervention to detect and treat bile leakage after cholecystectomy. ENBD and percutaneous drainage of abdominal collections can cure postcholeeystectomy bile leakage.

关 键 词：经内镜逆行胰胆管造影 鼻胆管引流 胆囊切除术 胆漏 

分 类 号：R657.4[医药卫生—外科学]