腹腔镜胆囊切除术后胆漏原因及处理探讨  

The approach on the causes and treatments of chole-leakage after laparoscopic cholecystectomy

作　　者：俞磊[1] 马良龙[1] 陈志刚[1] 崔经建[1] 

机构地区：[1]安徽省淮北市人民医院普外科,安徽淮北235000

出　　处：《吉林医学》2011年第11期2098-2100,共3页Jilin Medical Journal

摘　　要：目的:探讨腹腔镜胆囊切除术后胆漏发生的原因及处理措施。方法:回顾分析5例腹腔镜胆囊切除术后发生胆漏的临床资料。结果:胆囊管残端漏3例,迷走胆管漏1例,胆总管壁烧灼伤发生胆漏1例。其中1例胆囊管残端漏及1例胆总管壁烧灼伤发生胆漏的患者保持腹腔引流通畅;1例胆囊管残端漏患者再次行腹行胆囊管结扎术;迷走胆管漏患者行ERCP放置鼻胆管引流,同时再次行腹腔镜置管引流;1例胆囊管残端漏患者行ERCP放置鼻胆管引流。5例均痊愈出院。结论:胆囊管残端钛夹滑脱,迷走胆管损伤,胆总管壁烧灼伤及肝外胆管损伤是腹腔镜胆囊切除术后胆漏发生的主要原因。通畅腹腔引流、ERCP放置鼻胆管及及时再次手术是处理腹腔镜胆囊切除术后胆漏的重要措施。Objective To explore the causes and treatments of bile leakage after laparoscopic cholecystectomy（LC）.Methods The clinical data of five patients with chole-leakage were analyzed retrospectively.Results Five cases include three cases of gallbladder duct-leakage,one mini bile duct-leakage and one common bile duct-leakage.Intraperitoneal drainage was done in one stump leakage of cystic duct and two common bile duct-leakage.Laparotomy was done in one stump leakage of cystic duct.Another case with stump leakage of cystic duct underwent ERCP.The case with mini bile duct-leakage underwent ERCP and LC.All the 5 cases were cured and discharged.Conclusion The clip drop,mini bile duct and extrahepatic duct injuries are the key causes of bile leakage after LC.Intraperitoneal drainage,ERCP and reoperation are effective methods for chole-leakage after LC.

关 键 词：腹腔镜胆囊切除术 胆漏 处理 并发症 

分 类 号：R657.4[医药卫生—外科学]