T管周围胆汁渗漏的处理及预防措施（附25例报告）

目的 分析T管周围胆汁渗漏发生的原因,探讨预防措施和治疗方法.方法 回顾分析2010年3月至2014年7月治疗的25例T管周围胆汁渗漏病例,其中男性8例,女性17例,平均年龄56.6岁（25～82岁）,年龄≥65岁者19例.全部病人均行胆管探查术后放置T管.合并肝内胆管结石行肝左外叶切除7例,其中4例合并肝切除术后胆漏;合并急性化脓性胆管炎3例;术中诊断Mirizzi综合征2例,Ⅰ型及Ⅱ型各1例.分别行T管周围扩创置管引流、滴水双套管冲洗、经皮穿刺置管引流（PCD）、经胆道镜腹腔灌洗、腹腔置管引流、再次剖腹手术引流.结果 25例病人均痊愈出院.其中24例保守治疗痊愈,1例经再次剖腹手术获得治愈.结论 胆管探查术后T管周围胆汁渗漏发生原因很多,围手术期正确处理可降低其发生的概率.渗漏发生后均需行妥善引流,必要时再次手术,可以获得满意的治疗效果.

Causes and management of bile leakage around T tube: a report of 25 cases

Objective To analyze the etiology and explore the prevention measures and treatment methods of bile leakage around T tube.Methods A total of 25 patients with bile leakage around T tube were analyzed retrospectively.Debridement ＆ catheter drainage around T tube,double perfusion cannula irrigation,percutaneous catheter drainage （PCD）,peritoneal lavage by cholangioscopy,intraperitoneal catheter drainage and re-laparotomy with drainage were performed respectively.Results All recovered well.Except for 1 case of re-laparotomy,the remainder received conservative treatment and were cured.Conclusions There are multiple causes for bile leakage around T tube after bile duct exploration happens.Appropriate perioperative handling may reduce its occurrence.Proper drainage,or re-operation if necessary,must be adopted and satisfactory outcomes may be achieved.