腹腔镜胆囊部分切除术后胆漏的原因及处理

目的：探讨腹腔镜胆囊部分切除术（laparoscopic subtotal cholecystectomy,LSC）后胆漏的原因、预防方法及处理措施。方法：回顾分析26例LSC术后发生胆漏3例（0.12%）的原因。结果：1例为术中胆总管前壁被电刀点状灼伤,2例为迷走胆管损伤,均经保守治疗痊愈。结论：LSC术后近期患者腹痛应考虑胆漏的可能,迷走胆管损伤、胆管灼伤为腹腔镜胆囊部分切除术后胆漏的常见原因,要仔细辨别Calot三角解剖结构,在分离胆囊床和胆囊三角区时,应将纤维索组织钳夹后再切断,避免热传导损伤胆管。此外,要适时把握中转开腹的手术时机,这是预防胆漏等并发症发生的关键。

Causes and treatmemt of biliary fistula after laparoscopic subtotal cholecystectomy

Objective:To investigate the cause and management for bile leakage after laparoscopic subtotal cholecystectomy (LSC).Methods:Three bile leakage cases of 26 LSC procedure performed in the First Affiliated Hospital of Dalian Medical University were retrospectively analyzed.Results:Two cases of aberrant duct injury and 1 case of bile duct anterior wall scorched were cured by conservative therapy.Conclusions:Bile duct injury is the most common cause of bile leakage after LSC.Patent drainage,bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LSC.Distinguish anatomy structure of calots triangular area carefully.As abruptio bile-cyst and Calot' s trianglar area,fiber chorda should been cut off after ringed clamp.Avoid heat conduction to damage bile duct.It is the key step of grasping proper occasion of conversion to laparotomize to prevent complications such as biliary fistula.