腹腔镜胆囊切除术后迟发性胆漏12例报告  

Delayed Bile Leakage after Laparoscopic Cholecystectomy:Report of 12 Cases

作　　者：陈勇[1] 息颖[1] 李金龙[1] 张乙川[1] 王俊[1] 李劲[1] 

机构地区：[1]攀枝花学院附属医院肝胆外科,攀枝花617000

出　　处：《中国微创外科杂志》2009年第11期1010-1012,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后迟发性胆漏的原因、预防及处理措施。方法对我院1994年11月～2007年12月11000例LC后出现迟发性胆漏12例的发生机制、发病特点、处理方法及预后进行回顾性分析。结果热电效应引起的胆管穿孔性损伤8例,迷走胆管漏2例,原因不详2例。经B超引导下置管引流4例,镜下及开腹修补联合T管引流3例,腹穿联合鼻胆管引流(endoscopic nasobiliary drainage,ENBD)3例,腹穿联合胆道内支架(endoscopic retrograde biliary drainage,ERBD)1例,开腹胆总管空肠吻合术1例。所有病人均治愈出院,住院时间8～21d,平均15d。无腹腔感染、出血、再次胆漏、肠漏等并发症。引流术后10d左右复查B超或造影显示胆道无狭窄、扩张,造影剂排泄通畅。12例随访1年,无胆管狭窄及胆道感染的临床症状。结论热电效应引起胆管损伤是LC后迟发性胆漏的主要原因;术中操作轻柔,严格按解剖层次分离,是预防术后迟发性胆漏的关键;内镜和介入治疗是诊断及治疗迟发性胆漏的主要方法,有其独到的优势。Objective To Discuss the causes, prevention and treatment of delayed bile leakage following laparoscopic eholecystectomy （LC）. Methods From November 1994 to December 2007, totally 11 000 cases of LC were performed in our hospital, 12 of them developed delayed bile leakage after the procedure. The mechanism, characteristics, treatment, and prognosis of the disease were analyzed retrospectively. Results Among the twelve cases of delayed bile leakage, eight cases showed perforation of the bile duct caused by thermoelectric effect, two cases had leakage of the aberrant bile-duet, and two cases were injured by unknown reasons. B-ultrasonography-guided drainage was performed in four of the patients, laparoseopic or open repair combined with T-tube drainage were carried out in three, abdominal puncture combined with endoscopic nasobiliary drainage （ENBD） was clone in three, abdominal puncture with endoscopic retrograde biliary drainage （ERI3D） was made in one, and open repair and bilio-jejunal anastomosis was performed in one. All patients were cured and discharged in 8 to 21 days with a mean of 15 days. No intra-abdominal infection, hemorrhage, recurrent bile leakage or intestinal leakage occurred after the operations. Re-examination by B-ultrasonography or eholangiopanereatography performed ten clays after the drainage showed no stricture or dilation of the bile duct, and contrast media drained out fluently. The 12 eases were followed up for one year, none of them showed biliary stenosis or infections during the period. Conclusions Post-LC injury of the bile duct is mostly caused by thermoelectric effect. Gentle operation and separation strietly following the anatomical levels are the keys in prevention of postoperative delayed bile leakage; while endoscopy and interventional treatment are main methods for the diagnosis and treatment of the disease.

关 键 词：腹腔镜胆囊切除术 迟发性胆漏 热电效应 

分 类 号：R657.406[医药卫生—外科学]