腹腔镜胆囊切除术后表现不典型胆瘘的原因及防治  

Cause,Management and Prevention of Un-Typical Biliary Fistula after Laparoscopic Cholecystectomy

作　　者：孙登群[1] 龚仁华[1] 王敬民[1] 姜世涛[1] 鲍恩武[1] 钟兴国[1] 刘学停[1] 张勇[1] 

机构地区：[1]武警安徽省总队医院外一科,合肥230041

出　　处：《中国普外基础与临床杂志》2008年第4期278-280,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜胆囊切除（LC）术后表现不典型胆瘘的原因、预防及处理。方法对我院21例LC术后表现不典型胆瘘的病例作回顾性总结分析。结果本组患者均表现不典型，无明显腹膜炎体征，主要表现为：右上腹包块（6例）、上腹部隐痛（11例）、轻度腹胀（3例）及术后肠梗阻（1例）。确诊方法：腹腔穿刺（14例）、Trocar穿刺孔流出胆汁（6例）及剖腹探查（1例）。胆瘘原因包括：胆囊管残端瘘（2例），胆囊床毛细胆管瘘或迷走胆管瘘（9例），副肝管瘘（4例）。治疗以再次腹腔镜探查及B超引导下穿刺引流为主。所有的患者均顺利康复出院，无死亡病例。19例得到随访，随访3个月～2年，平均1．1年，恢复良好。结论LC术后表现不典型胆瘘比较少见，容易导致误诊、误治；加强对LC术后胆瘘的认识，注意对LC术后患者主诉及腹部体征的观察，可以早期发现术后胆瘘；治疗主张早期再次腹腔镜探查，如有包裹，可用B超引导下穿刺引流。Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy （LC）. Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant （6 cases）, vague pain of epigastric zone （11 cases）, abdominal distention （3 cases） and bowel obstruction （1 case） after operation were main manifestations. Abdominal paracentesis （14 cases）, bile exuded from incisional opening of trocar （6 cases） and exploratory laparotomy （1 caes） were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula （2 cases）, aberrant bile-duct fistula （9 cases）, and accessory hepatic duct fistula （4 cases）. Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nine- teen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce, and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC, and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.

关 键 词：胆囊切除 腹腔镜 胆瘘 治疗 

分 类 号：R657.4[医药卫生—外科学]