27例胆道手术后胆漏的原因及治疗  

Treatment of biliary fistula after bile duct surgery: report of 27 cases

作　　者：赵登秋[1] 束芳明[1] 蒋厚文[1] 朱克明[1] 

机构地区：[1]徐州医学院附属淮安医院普外科,淮安223002

出　　处：《中华普通外科杂志》2001年第10期607-608,共2页Chinese Journal of General Surgery

摘　　要：目的　探讨胆道术后发生胆漏的原因及其预防措施与治疗方法。方法　对 1991～2 0 0 0年间 3 786例胆道术后发生胆漏的 2 7例临床资料作回顾性分析。结果　 2 7例术后发生胆漏的原因为肝床毛细胆管或细小副肝管损伤 8例、胆总管癌切开探查后胆漏 1例、胆囊管或胆囊颈部残端漏 7例、T管早期滑脱或拔T管后胆漏 10例、T管引流术后护理不当 1例。本组保守治疗 2 1例( 78% ) ,再手术治疗 6例 ( 2 2 % ) ;除 1例胆管癌晚期自动出院外 ,其余均痊愈出院。结论　胆漏多发生于胆囊切除术及拔T管后 ,主要原因为与肝床毛细胆管或细小副肝管损伤、局部炎症和操作不当等有关。胆漏发生后应根据腹膜炎的轻重、胆道有无梗阻以及腹腔引流是否通畅等选择保守治疗与再手术治疗。Objective To investigate the cause, prevention and treatment of biliary fistula after biliary tract operation.Methods Biliary fistula developed postoperatively in 27 out of 3*!786 patients undergoing bile duct surgery from 1991 to 2000. Results Injury of liver bed cholangiole or tiny accessory hepatict duct occured in 8 cases, 1 developed after incision and exploration of CBD in biliary duct cancer, stump leakage of cystic duct in 7, early T tube inadvertent sliding off or after T tube removement in 10. 21 patients underwent conservative therapy (78%), 6 reoperation (22%). Fistula was cured in 26 cases, the remaining one who suffering from late staged bile duct cancer died. Conclusions Biliary fistula often occurs after cholecystectomy, and after the removal of a T tube. Conservative therapy is often successful unless there is a frank peritonitis, biliary tract obstruction, or improper peritoneal drainage.

关 键 词：术后并发症 胆漏 病因 治疗 胆道手术 

分 类 号：R657.4[医药卫生—外科学]