腹腔镜胆囊切除术后胆漏的原因分析和防治  

Causes,prevention and treatment of bile leakage following laparoscopic cholecystectomy

作　　者：孙镇蛟 林森旺[1] 

机构地区：[1]上海市中西医结合医院微创外科,上海200082

出　　处：《中国微创外科杂志》2004年第2期130-131,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)后胆漏的原因和防治。　方法　对 1993年 10月～ 2 0 0 3年 10月十年中 36 2 6例腹腔镜胆囊切除术后并发 9例胆漏进行回顾性分析。　结果　 6例经腹腔引流术 ,其中 1例胆囊管残端漏者联合内镜下鼻胆管引流术治疗 ;腹腔镜探查 3例 ,1例胆囊管残端钛夹夹闭不全者在腹腔镜下重新夹闭成功 ,2例胆管损伤者中转开腹。 9例均治愈出院 ,随访 1～ 9年 ,平均 3 7年 ,无胆道并发症发生。　结论　腹腔镜胆囊切除术后胆漏应早期诊断和及时治疗 ,肝下放置引流管有重要价值 ,但关键在预防。Objective To investigate the causes, prevention and treatment of bile leakage following laparoscopic cholecystectomy (LC). Methods Nine cases of postoperative bile leakage out of 3626 cases of LC between October 1993 and October 2003 were retrospectively reviewed. Results Intraperitoneal drainage was conducted in 6 patients and one of them (stump leakage of cystic duct) also underwent endoscopic nasal biliary drainage (ENBD). The remaining 3 patients received laparoscopic exploration : 1 patient with incomplete clipping of cystic duct stump underwent laparoscopic re-clipping successfully and a conversion to open repair of cystic duct was required in the other 2 patients with bile duct injuries. All the 9 patients were cured and discharged postoperatively. Follow-up in the 9 patients for (1～9) years (mean, 3 7 years) revealed no bile duct complications.Conclusions Bile leakage following LC should be diagnosed and treated as soon as possible. Although subhepatic drainage is of great importance, emphasis should be on the prevention .

关 键 词：腹腔镜胆囊切除术 胆漏 回顾性分析 

分 类 号：R657.4[医药卫生—外科学]