内镜下胆道支架置入治疗肝胆外科术后胆漏的临床观察

目的探讨内镜下胆道支架置入对肝胆外科手术后胆漏的治疗效果。方法回顾性分析我院2001年1月～2005年12月收治的11例肝胆外科术后胆漏，提出胆漏新的临床分型：Ⅰ型，胆囊管漏；Ⅱ型，肝外胆管漏（漏口直径小于胆管直径1／3的为A型，大于1／3为B型）；Ⅲ型，肝内胆管漏（肝内胆管盲端漏为A型，引流肝段以下的肝内胆管漏为B型，引流肝段以上的肝内胆管漏为C型）；Ⅳ型，Luschka管漏。结果11例中Ⅰ型6例，ⅡA型2例，ⅢA型1例，ⅢB型2例。4例行单纯支架置入，7例行Oddi括约肌切开联合支架置人。术后3周拔除支架6例，1个月拔除支架2例，2周、6个月和9个月拔除支架各1例。11例经内镜治疗后腹痛缓解，腹腔胆汁引流消失，黄疸消退。1例随访6个月，10例随访1—3年，均未复发腹痛、发热、黄疸、腹腔积液，血胆红素正常。结论内镜下胆道支架置入是治疗肝胆外科术后大多数胆漏的有效手段之一，胆漏新临床分型对治疗方法的选择具有一定的指导意义。

Clinical Value of Endoscopic Biliary Stent Placement for Bile Leakage Following Hepatobiliary Surgery

Objective To explore therapeutic efficacy of endoscopic biliary stent placement in the management of bile leakage following hepatobiliary surgery.Methods 11 cases of bile leakage following hepatobiliary surgery were reviewed retrospectively from January 2001 to December 2005.New clinical classifications of bile leakage were proposed: type I,leakage from cystic duct;type II,leakage from extrahepatic bile duct(diameter of leakage less than 1/3 diameter of biliary duct was type IIA;more than 1/3 was type IIB);type III,leakage from intrahepatic bile duct(leakage from intrahepatic bile duct cecum was type IIIA;leakage from intrahepatic bile duct under draining hepatic segments was type IIIB;above draining hepatic segments was type IIIC);type IV,leakage from Luschka duct.Results In 11 cases,there were 6 cases of type I,2 cases of type IIA,1 case of type IIIA,and 2 cases of type IIIB.4 cases were placed only stents,and Oddi sphincterotomy combined with stent placement were performed in 7 cases.Stents were taken out at 3 weeks(6 cases),1 month(2 cases),2 weeks(1 case),6 months(1 case) and 9 months(1 case) postoperatively.Abdominal pain was relieved in 11 cases after endoscopic treatment,with disappearance of biliary drainage from abdominal cavity and subsidence of jaundice.1 case was followed up for 6 months,and other 10 cases were followed up for 1-3 years,with no recurrence of abdominal pain,fever,jaundice and seroperitoneum,and hemobilirubin became normal.Conclusions Endoscopic biliary stent placement is one of effective therapeutic procedures in the management of most bile leakage following hepatobiliary surgery.New classification of bile leakage may be taken as a guide to select therapeutic procedures.