ERCP联合腹腔置管引流治疗肝胆手术后胆漏的效果  

The efficacy of ERCP combined with abdominal catheter drainage in the treatment of biliary leakage after hepatobiliary surgery

作　　者：钟谷平 范惠珍 盛建文 桂冠 谢萍 李骥 ZHONG Guping;FAN Huizhen;SHENG Jianwen;GUI Guan;XIE Ping;LI Ji(Department of Gastroenterology,Yichun People's Hospotial,Yichun,Jiangxi,336000,China)

机构地区：[1]宜春市人民医院消化内科,江西宜春336000

出　　处：《当代医学》2021年第15期70-72,共3页Contemporary Medicine

摘　　要：目的探讨经内镜逆行性胰胆管造影术(ERCP)联合腹腔置管引流对肝胆手术后胆漏的治疗效果。方法回顾性分析2010年1月至2018年12月在本院接受ERCP和腹腔置管引流治疗的24例肝胆手术后胆漏患者的临床资料,分析ERCP联合腹腔置管引流治疗肝胆手术后胆漏的效果。结果24例胆漏患者中,肝内胆管漏6例,胆总管漏8例,胆囊管残端漏10例,所有患者均先行腹腔置管引流术再行ERCP,其中内镜下鼻胆管引流术(ENBD)10例,行胆管内支架引流术(ERBD)8例,行ERBD+ENBD术6例,行十二指肠乳头括约肌切开(EST)+胆总管取石4例,2例治疗失败,包括1例ERBD,1例ENBD,转外科手术。ERCP联合腹腔置管引流治疗胆漏有效率为95.8%(23/24),胆漏愈合时间为6~57 d,胆囊管残端漏有效治愈率最高,为100%,愈合时间最短,为5~11 d;胆总管漏愈合率为87.5%(7/8),肝内胆管漏愈合率83.3%(5/6);ERBD+ENBD术患者胆漏全部治愈。结论ERCP联合腹腔置管引流治疗肝胆手术后胆漏安全有效,治愈率高,尤其对于胆囊管残端漏效果更好,根据胆管漏口位置及漏口大小行ENBD或ERBD,必要时可行ENBD+ERBD联合腹腔置管引流术。Objective To investigate the efficacy of retrograde endoscopic cholangiopancreatography(ERCP)combined with abdominal catheter drainage in the treatment of biliary leakage after hepatobiliary surgery.Methods Clinical data of 24 patients who received ERCP and abdominal catheter drainage in our hospital from January 2010 to December 2018 were retrospectively analyzed,and the efficacy of ERCP combined with abdominal catheter drainage in the treatment of postoperative bile leakage after hepatobiliary surgery was analyzed.Results Among the 24 cases of bile leakage,there were 6 cases of intrahepatic bile leakage,8 cases of common bile duct leakage and 10 cases of cystic duct stump leakage all patients were abdominal cavity drainage tube after ERCP any first,including endoscopic nose biliary drainage(ENBD)in 10 cases,lines of bile duct stent drainage(ERBD)8 cases,line ERBD+ENBD 6 cases,lines of duodenal papilla sphincter incision(EST)+bravery manager stone 4 cases,2 cases of treatment failure,including 1 case of ERBD,1 case of ENBD,turn to surgery.The effective rate of ERCP combined with abdominal catheter drainage for bile leakage was 95.8%(23/24),and the healing time of bile leakage was 6-57 d.The effective cure rate of bile duct stump leakage was the highest(100%),and the healing time was the shortest of 5-11 d.The rate of common bile duct leakage healing was 87.5%(7/8),the rate of intrahepatic bile duct leakage healing was 83.3%(5/6).All patients with biliary leakage were cured after ERBD+ENBD.Conclusion ERCP combined with abdominal catheter drainage is safe and effective in the treatment of biliary leakage after hepatobiliary surgery,with high cure rate,especially for the residual leakage of cystic duct.ENBD or ERBD can be performed according to the location and size of bile duct leakage,and when necessary,ENBD+ERBD combined with intraperitoneal catheter drainage can be performed.

关 键 词：ERCP 腹腔置管引流 肝胆手术后 胆漏 

分 类 号：R657.4[医药卫生—外科学]