应用内镜下逆行胰胆管造影、内镜下鼻胆管引流术治疗腹腔镜胆囊切除术后胆漏10例分析  

Biliary leakage after laparoscopic cholecystectomy(LC) treated with endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic naso-biliary drainage(ENBD):An analysis of 10 cases

作　　者：王瑞官[1] 李为民[1] 郑方[1] 刘浩润[1] 吴田田[1] 刘航[1] 吕家辉 

机构地区：[1]中国人民解放军第309医院肝胆外科,北京100091

出　　处：《中国实用外科杂志》2015年第7期763-765,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨内镜下逆行胰胆管造影（ERCP）、内镜下鼻胆管引流术（ENBD）治疗腹腔镜胆囊切除术（LC）后胆漏的安全性及有效性。方法回顾性分析2010年5月至2014年6月中国人民解放军第309医院对10例LC术后胆漏病人行ERCP、ENBD的临床资料。结果 10例病人均成功实施ERCP检查,进一步证实为胆漏。其中肝总管漏4例、右肝管漏2例、胆囊管残端漏4例。胆管内结石3例,行内镜下十二指肠乳头括约肌切开术（EST）取石。所有病人均放置鼻胆管,平均手术时间40（30~60）min。术中、术后无并发症发生。术后第1天复查血尿淀粉酶无明显异常,术后第2天病人可进流食。10例全部治愈,平均愈合时间为9（7~10）d。结论 ERCP、ENBD治疗LC术后胆漏安全、有效,可作为处理术后胆漏的首选方法。Objective To explore the safety and effectiveness of endoscopic retrograde cholangiopancreatography（ERCP） and endoscopic naso-biliary drainage（ENBD） in the treatment of biliary leakage after laparoscopiccholecystectomy（LC）.Methods The clinical data of 10 cases of biliary leakage after LC received ERCP and ENBDbetween May 2010 and June 2014 in the 309 th Hospital of PLA were analyzed retrospectively.Results All the caseswere operated with ERCP successfully and confirmed with biliary leakage. There were 4 cases of common hepatic ductleaks,2 cases of right hepatic duct leaks and 4 cases of cystic duct stump leaks. Residual stones occurred in 3 cases,which were operated with endoscopic sphincterotomy（EST） and calculus removed. ALL the cases were placed withnaso-biliary drainage tube. The operative time ranged from thirty minutes to sixty minutes with a mean of forty minutes.No intraoperative and postoperative complication occurred. The blood amylase and urinary amylase were normal at thefirst day postoperatively. The patients could eat liquid diet at the second day postoperatively. All the cases were curedcompletely. The healing time for biliary leakage ranged from seven days to ten days with a mean of nine days.Conclusion ERCP and ENBD are safe and effective diagnosis and nonoperative methods to treat biliary leakage afterLC. It can be used as the preferred treatment for bile leakage.

关 键 词：内镜逆行胰胆管造影 鼻胆管引流术 腹腔镜胆囊切除术 胆漏 

分 类 号：R6[医药卫生—外科学]