肝胆疾病术后胆漏发生原因与处理方法的分析  

Causes and treatments of bile leakage after operation of hepatobiliary diseasesJ

作　　者：谷化剑[1] 陈俊华[1] 冯贤松[1] 辛小燕[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《腹部外科》2012年第1期16-18,共3页Journal of Abdominal Surgery

摘　　要：目的探讨肝胆疾病手术后发生胆漏的原因及其预防与治疗方法。方法对2005年1月至2010年9月收治的肝胆疾病术后发生胆漏42例的临床资料作回顾性分析。结果腹腔镜胆囊切除术10例，开腹胆囊切除术5例，开腹胆囊部分切除术2例，胆囊切除、胆道探查、T管引流术6例，胆肠吻合术后9例，肝叶切除术后5例，拔除T管后胆漏4例，经皮肝穿胆管外引流术后1例。经B型超声、剖腹探查等确定胆漏原因有Luschka胆管损伤、胆囊管或部分胆囊残端漏、右肝管损伤、肝断面胆漏、T管旁胆管壁漏、胆肠吻合口漏、T管窦道未形成致胆漏。非手术治疗37例（88．1％），再手术5例（11．9％），均痊愈出院。结论胆漏发生原因与病人营养及代谢状况、病变局部病理因素、胆道解剖变异因素及术者技术因素有关；胆漏的治疗应个体化，根据胆漏发生原因、类型、腹膜炎程度等选择非手术治疗与手术治疗。Objective To research the causes, treatments and preventions of bile leakage after the surgical operation. Methods A retrospective analysis was performed on 42 surgically treated cases with bile leakage from Jan. 2005 to Sept. 2010. Results Among the 42 patients, bile leakage was caused by laparoscopic cholecystectomy＇in 10 cases, operative cholecystectomy in 5 cases, subtotal cys- tectomy in 2 cases, common bile duct （CBD） exploration and T tube drainage in 6 cases, cholangiojejunostomy in 9 cases, hepalobectomy in 5 cases, biIe leakage after T tube extraction in 4 cases and percu- taneous transhepatic cholangiodrainage in 1 case. The mechanisms of bile leakage included Luschka bile duct injury,residual cystic duct or gallbladder bile leakage, right hepatic duct damage, bile leakage at the wound surface after liver resection,CBD leaking beside T tube, stomal leaking and bile leakage due to unformed sinus by T tube. The cases were successfully cured by non-surgical approach in 37 cases （88. 1%） and reoperation in 5 cases （11.9%）. Conclusion The reasons of bile leakage are related to nutrition and metabolism of patients, local pathological changes of the lesions, bile duct variable anato- my and the skills of the operators. The treatments are determined by the causes and types of bile leak- age,the severity of peritonitis, and the other general conditions of the patients.

关 键 词：胆道外科手术 手术后并发症 胆漏 

分 类 号：R657.4[医药卫生—外科学]