肝胆外科术后胆漏73例治疗分析  

Treatments for biliary leakage after hepatobiliary surgery:analysis of 73 cases

作　　者：柴乃俊 高鹏[2] 杨晓军[2] 蒋泽斌[2] 马炳强[2] Chai Naijun;Gao Peng;Yang Xiaojun;Jiang Zebin;Ma Bingqiang(the First School of Clinical Medicine,Lanzhou University,Lanzhou 730001,China;DepartmentⅡof General Surgery,Gansu Provincial Hospital,Lanzhou 73000,China)

机构地区：[1]兰州大学第一临床医学院,730000 [2]甘肃省人民医院普外二科,730000兰州

出　　处：《中华肝脏外科手术学电子杂志》2020年第1期58-61,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81660398)。

摘　　要：目的探讨肝胆外科术后胆漏的治疗策略及疗效。方法回顾性分析2010年1月至2018年8月在甘肃省人民医院行肝胆外科手术后发生胆漏的73例患者临床资料。其中男35例,女38例;年龄21~75岁,中位年龄56岁。患者均签署知情同意书,符合医学伦理学规定。观察患者胆漏发生情况、治疗及疗效。结果同期行肝胆手术12780例,胆漏发生率0.57%(73/12780)。其中腹腔镜胆囊切除术后胆漏32例,腹腔镜胆总管探查取石术后23例,胆肠吻合术后11例,肝切除术后7例。采用双套管负压冲洗引流治疗15例,经皮经肝胆道引流术(PTCD)+超声引导下腹腔穿刺引流治疗8例,内镜下鼻胆管引流术(ENBD)治疗4例,ERCP治疗1例,均治愈。单纯性腹腔引流治疗17例,治愈13例;超声引导下腹腔穿刺引流治疗18例,治愈16例。二次手术治疗10例,治愈8例。总治愈率89%(65/73),8例未愈,其中1例死于二次手术后腹腔出血。结论肝胆外科术后胆漏发生率仍较高,应尽早判断胆漏位置和严重程度,尽可能选择微创治疗,避免盲目进行二次手术。Objective To explore the therapeutic strategy and efficacy of bile leakage after hepatobiliary surgery.Methods Clinical data of 73 patients with bile leakage after hepatobiliary surgery admitted to Gansu Provincial Hospital from January 2010 to August 2018 were retrospectively analyzed.Among them,35 patients were male and 38 female,aged from 21 to 75 years with a median age of 56 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The incidence of bile leakage,treatments and clinical efficacy were observed.Results A total of 12780 patients underwent hepatobiliary surgery in the same period.The incidence rate of bile leakage was 0.57%(73/12780).32 patients suffered from bile leakage after laparoscopic cholecystectomy,and 23 cases after laparoscopic choledocholithotomy,11 cases after choledochojejunostomy and 7 cases after hepatectomy.15 cases were treated with double-cannula vacuum douche and drainage,8 received percutaneous transhepatic cholangiodrainage(PTCD)combined with ultrasound-guided abdominal puncture and drainage,4 were treated with endoscopic nasobiliary drainage(ENBD)and 1 received encoscopic retrograde cholangiopancreatography(ERCP).All patients were cured.17 cases were treated with simple abdominal drainage,in which 13 were cured.18 cases received ultrasound-guided abdominal puncture and drainage,and 16 were cured.10 cases underwent secondary operation,and 8 were cured.The total cure rate was 89%(65/73).Treatments in 8 cases failed,in which 1 case died of abdominal hemorrhage after the secondary operation.Conclusions The incidence of bile leakage after hepatobiliary surgery remains relatively high.The location and severity of bile leakage should be determined as early as possible.It is highly recommended to choose minimally invasive treatment to avoid the secondary surgery.

关 键 词：胆漏 胆囊切除术 腹腔镜 胆管肠吻合术 肝 治疗 

分 类 号：R657.4[医药卫生—外科学]