T管引流术后胆漏的预防和治疗

目的探讨T管引流术后胆漏的预防和治疗措施。方法对本组2001年1月至2006年6月治疗的9例胆总管切开探查T管引流术后发生胆漏的临床资料进行回顾性分析。结果本组9例术后胆漏中,6例采用非手术方法治疗,3例采用再手术治疗。所有患者均被治愈出院。住院时间是10～26天(平均14.5d)。术后无肠瘘、胆道出血、腹腔感染和切口感染等并发症。结论预防T管引流术后胆漏的重要措施是掌握好手术指征,了解术中胆道的变异,细致的手术操作,保持术后T管引流通畅和改善患者的全身情况等。一旦术后发生胆漏,应尽快找出其原因并进行针对性处理。大多数患者经积极的非手术治疗是可治愈的。但是,对胆漏量较大并引起严重并发症者应立即手术处理。

Prevention and cure of bile leakage after T tube drainage

Objective To investigate the measures of prevention and cure of bile leakage after T tube drainage. Methods From January 2001 to June 2006, 9 cases with bile leakage after choledochotomy with exploration and T tube drainage were analyzed retrospectively. Results In the 9 cases of postoperative bile leakage, All cases were cured to discharge from hospital. Hospitalization time was 10 to 26 days (mean 14.5days). No intestinal fistula, hemobilia, abdominal infection and incisional infection were found after operation. Conclusions It is very important measures for preventing biliary leakage after T tube drainage, which includes grasping operation indications, understanding variation of intraoperative biliary anatomy, meticulous surgical manipulation, keeping unobstruction of postoperative T tube drainage and improving patient's general condition, etc. Once postoperative biliary is occurred, it's cause should be searched as early as possible and to the point management should be done at the same time. Via active conservative treatment, most of patients may be cured. But, when the amount of biliary leakage is massive and it induce severe complication, the surgical treatment shoulod be performed immediately.