腹腔镜胆总管探查T管引流术后胆漏的发生原因及对策

目的:探讨腹腔镜胆总管探查T管引流术后胆漏的发生原因、预防方法及处理措施。方法:对395例腹腔镜胆总管探查T管引流术后21例胆漏患者的临床资料进行回顾性分析。结果:胆管切口漏胆13例,其中4例经术中常规放置的腹腔引流管引流自愈,9例联合内镜乳头切开和鼻胆管引流治愈。术后T管早期滑脱4例和常规拔T管4例均导致胆汁性腹膜炎,经再次手术置T管和腹腔引流管治愈。结论:腹腔镜胆总管探查T管引流术后胆管切口漏胆、术后T管早期滑脱和T管瘘道形成不全是胆漏发生的主要原因,保持或建立通畅的腹腔引流和胆管引流是治疗胆漏的主要处理措施。

Causes and management for bile leakage after T-tube drainage of laparoscopic bile duct exploration

Objective: To investigate the causes,prevention and management of bile leakage after T-tube drainage of laparoscopic bile duct exploration(TLBDE).Methods: Datas of 21 bile leakage cases out of 395 TLBDE procedure performed in our department were retrospectively analyzed.Results: Bile leakage of 13 cases caused by the bile from exploratory incision of biliary duct to leak through into the peritoneal cavity was cured by patent drainage of TLBDE in 4 cases and endoscopic drainage in 9 cases.Peritonitis of bile leakage was cured by surgery and patent drainage in 8 cases.Conclusion: The main causes of bile leakage after TLBDE were the unhealed incision of the bile duct,early slip out of the T-tube,incomplete T-tube fistula.Patent drainage and T-tube drainage are the main methods for the treatment of bile leakage after TLBDE.