腹腔镜胆囊切除术后胆漏的临床分析

目的:探讨腹腔镜胆囊切除术后胆漏的原因、预防和治疗。方法:回顾分析2000年1月—2011年9月复旦大学附属中山医院青浦分院10例腹腔镜胆囊切除术后胆漏患者的临床资料。结果:1例开腹置管腹腔引流;5例置鼻胆管引流,并继续原腹腔引流,其中1例因腹腔引流管滑脱而剖腹冲洗后重置腹腔引流管;3例置鼻胆管引流,同时行超声引导下穿刺引流;1例开腹行胆管空肠Roux-en-Y吻合;全部患者于2～5周内痊愈。结论:腹腔镜胆囊切除术后出现胆漏应早期充分引流,一旦怀疑胆漏应尽早行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)检查,但关键在于预防胆漏。

Bile Leak after Laparoscopic Cholecystectomy

To investigate the causes, prevention and treatment of bile leak after laparoscopic cholecystectomy. Methods： A total of 10 cases with bile leak after laparoscopic cholecystectomy were retrospectively reviewed from January 2000 to September 2011. Results： One case was cured after reoperation; five cases were performed endoscopic nasobiliary drainage （ENBD） with abdominal drainage retained, one of them was transfered to open operation for losing of drainage tube; three cases were performed endoscopic nasobiliary drainage and puncture-drainage under the guide of ultrasonography; one case was per- formed Roux-en-Y choledochojejunostomy. All patients were cured in 2 to 5 weeks. Conclusions： Early sufficient drainage is ef- fective for bile leak after laparoscopic cholecystectomy. Endoscopic retrograde cholangiopancreatography （ERCP） should be taken once bile leak happen. The key for preventing bile leak is taking prophylactic measures during the operation.