胆漏的原因及防治（附２２例报告）

目的 探讨胆漏的原因及防治策略。方法 回顾分析了１９９３年１月至１９９８年１２月收治的２２例胆漏病人发生胆漏的原因、治疗方法及效果。结果 １９例首选非手术治疗，其中１例死亡，３例中转手术治疗，余１５例治愈，非手术治愈率７９％（１５／１９）。３例首选急诊手术治愈。３例中转手术病人中，１例再手术时遗漏对胆管结扎伤的处理,余２例治愈。全组总治愈率为９１％（２０／２２）。结论 胆漏多发生于胆囊切除术及Ｔ管排除后，主要与炎症、粘连、解剖变异和操作不仔细有关，预防应从首次手术前、中、后三个环节着手，胆漏发生后应根据胆漏大小、病情轻重选择手术治疗和非手术治疗。

Causes and treatment of bile leakage(a report of 22 cases).

Objective To investigate the cause,prevention and treatment of bile leakage.Methods The clinical data of 22 cases with bile leakage treated from Jan.1993 to Dec.1998 were reviewed retrospectively.Results Of the 19 cases treated with nonoperative therapy,1 patient died,3 patients were transferred to be operated later,and the other 15 cases were cured.The cure rate of nonoperation was 79%(15/19).3 patients were cured with emergent operation at the beginning of bile leakage.Of the 3 cases who were transferred to be operated later,2 cases were finally cured by operation while the other 1 patient was not cured.The total cure rate was 91%(20/22).Conclusion Bile leakage often occurs in cholecystectomy procedure and after removal of a T tube,which is mainly related to inflammation, adhesion,abnormality of anatomy and incorrect manipulation.In order to prevent it,surgeons should pay more attention to the 3 links of primary procedure, including preoperative preparation,operative management and postoperative treatment.Different treatments are optional according to the degree of leakage and the condition of patients.