腹腔镜胆囊切除术中损伤副肝管导致迟发性胆漏的腹腔镜治疗价值

目的:评价腹腔镜手术处理腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)损伤副肝管导致的迟发性胆漏的临床价值。方法:回顾分析2005~2012年14例患者LC术中损伤副肝管导致迟发性胆漏术后再次行腹腔镜手术的临床资料。结果:14例均顺利完成再次腹腔镜探查,其中4例迷走胆管损伤,予以电凝胆囊床、创面喷洒封闭胶后痊愈;8例副肝管管壁部分损伤,直接使用Hem-o-lok夹闭、留置T管或输尿管导管引流胆管,2个月后拔除,患者痊愈;2例副肝管横断,再次于腹腔镜下留置输尿管导管引流胆管,2个月后开腹行胆肠吻合或胆管吻合术。患者均于网膜囊孔、膈下或盆腔留置腹腔引流管。结论:LC术中损伤副肝管导致的迟发性胆漏由于腹腔内炎症水肿严重,不具备胆管一期吻合条件,再次经腹腔镜处理可完成除吻合外的操作,具有直观、有效、微创的优点,效果满意。

The application value of laparoscope in delayed bile leakage caused by accessory hepatic duct injury after laparoscopic cholecystectomy

Objective：To evaluate the application of laparoscopic exploration in delayed bile leakage caused by accessory hepatic duct injury after laparoscopic cholecystectomy.Methods：We retrospectively reviewed 14 cases of delayed bile leakage who were diagnosed and treated by laparoscopic exploration from 2005 to 2012.Results：Laparoscopic exploration completed eventfully in all the 14 cases.Aberrant duct injury occurred in 4 cases and were treated by electrocoagulating the gallbladder bed and spraying medical sealant.Partial damage of accessory hepatic duct wall occurred in 8 cases and treated with hemo-lock to close the damage,T tube or ureteral catheter to drain bile duct and removed 2 months later.The previous 12 cases recovered eventfully.Accessory hepatic duct transaction occurred in 2 cases.Urethral catheter was used to drain bile duct and choledochojejunostomy or bile duct anastomosis was performed via laparotomy 2 months later.Drainage tube was placed in foramina of Winslow,Subphrenic fossa or Douglas＇ space in all cases.Conclusions：Since there are seriously inflammation and edema in delayed bile leakage patients caused by accessory hepatic duct injury during laparoscopic cholecystectomy,one-stage anastomosis could not performed.The laparoscopic exploration can not only deal with almost all the situations except anastomosis but also with many benefits,such as intuitive,effective,mini-invasive and with satisfactory outcomes.