腹腔镜胆囊切除术后胆漏的原因分析和防治

目的:探讨腹腔镜胆囊切除术后胆漏的原因和防治。方法:对1996年5月~2006年5月10年中我院3 246例腹腔镜胆囊切除术后并发的6例胆漏,及从外院转来我院的腹腔镜胆囊切除术后并发的4例胆漏进行回顾性分析。结果:6例行腹腔引流术;3例行腹腔镜探查,其中1例胆囊管残端钛夹滑脱重新夹闭成功,2例胆管损伤者中转开腹;1例经MRCP证实胆囊管残端漏合并胆总管结石,行腹腔镜下冲洗置管引流术,3周后开腹手术。10例均治愈出院。随访1~9年,平均3.7年,1例术后1年出现胆管狭窄行二次手术。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。

Causes,prevention and treatment of bile leakage following laparoscopic cholecystectomy

Objective To investigate the causes,prevention and treatment of bile leakage following laparoscopic cholecystectomy(LC).Method Ten cases postoperative bile leakage were retrospectively analysed. Results Intraperitoneal drainage was done in 6 patients.Three cases underwent laparoscopy,and one of them(stump leakage of cystic duct) was repaired below laparoscope,laparotomy was done in the other 2 cases with bile duct injuries.One case with stump leakage of cystic duct combining choledocholith underwent laparotomy at the 4th week after drainage.ALL the 10 patients were cured and discharged.Follow-up in the 10 patients for 1-9 years(mean 3.7years) revealed no bile duct complications.Conclusions Bile leakage following LC should be early diagnosed and treated as soon as possible.Although subhepatic drainage is of great importance,emphasis should be on the prevention.