腹腔镜探查术在腹腔镜胆囊切除术后胆漏诊治中的应用

目的探讨腹腔镜探查术在腹腔镜胆囊切除术后胆漏诊治中的应用价值。方法对1999-2004年收治的13例腹腔镜胆囊切除术后胆漏患者应用腹腔镜探查技术的诊治过程进行回顾性分析。结果3例确诊为肝外胆管损伤致胆漏，术中转开腹手术；10例被确诊为胆瘘(4例胆囊管瘘，3例迷走胆管瘘，3例副肝管损伤后胆瘘)，4例胆囊管漏和2例副肝管损伤者行腹腔镜下缝扎或钛夹夹闭，另1例副肝管损伤采用腹腔镜下置T管引流，所有胆瘘病例均在右肝下置腹腔引流管，10例胆瘘腹腔镜探查术后均痊愈。结论腹腔镜探查术在腹腔镜胆囊切除术后胆漏诊断尤其是胆瘘的治疗方面能充分发挥其有效和微创价值。

Laparoscopic exploration in diagnosis and treatment of bile leakage after laparoscopic cholecystectomy

Objective]To evaluate the effects of Laparoscopic exploration in the diagnosis and treatment of bile leakage after laparoscopic cholecystectomy(LC). 13 cases of bile leakage after LC from 1999 to 2004 were retrospectively reviewed,which were diagnosed and treated with Laparoscopc exploration. 3 cases was caused by extrahepatic injury ,and conversion to open surgery.10 cases were diagnosed bile fistula, including 4 cases of cystic duct stump fistula, 3 cases of aberrant duct and 3 cases of accessory bile duct injury. 4 cases of cystic duct stump fistula and 2 cases of accessory bile duct injury were sutured or closed with titanium clamp under laparoscopic. Another case of accessory bile duct injury received T-tube draining. All cases of bile fistula were received draining of abdominal cavity, and they were recovery. Conclusions] Laparoscopic exploration has efficiency and microinvasion value in the diagnosis of bile leakage after LC, especially in the treatment of bile fistula.