胆囊床胆管的损伤与处理对策

目的　提高对胆囊床胆管及其损伤的认识和处理对策。方法　回顾性分析了胆囊切除后胆囊床胆管损伤 37例的诊治情况。结果　 37例中 ,证实为Luschka胆管 17例、胆囊肝管 4例、右前叶肝管及其分支 3例 ;其余 13例仅发现胆瘘而未见损伤胆管。本组 30例经胆瘘处缝合引流或单纯引流治愈 ,4例未置引流者因局限性胆汁积聚经皮置管或穿刺引流治愈 ,另 3例因病情恶化而再次剖腹手术。结论　胆囊切除时易致胆囊床胆管损伤 ,术中仔细检查裸露胆囊床有无胆瘘应列为常规步骤 ,一旦发现有胆瘘 ,不论对胆漏处如何处理均应放置引流

Management of bile duct injury in gallbladder bed

Objective To explore the causes for the bile duct injury in gallbladder bed and investigate its diagnosis and management. Methods The data of 37 cases of bile duct injury in the gallbladder bed after cholecystectomy between January 1988 and March 1998 were retrospectively analyzed. Results According to the operative records, 17 among the 37 cases had leakage from Luschka bile duct, 4 from the cholecystohepatic duct and 3 from the right lobular hepatic duct and its branches. The sources of the leakage were not identified in other 17 cases. The injured sites were sutured and drained or drained alone in 30 cases. The other 4 cases without drainage were percutaneously under the ultrasonographic guidance because of an intra abdominal bile collection. The remaining 3 cases were surgically treated again for aggravation of the illness in them. Conclusions During performance of cholecystectomy, surgeons should pay close attention to the bile duct in the gallbladder bed for its vulnerable position. Careful inspection of the gallbladder bed should be a routine procedure after the operation. Once the bile leakage was recognized in the gallbladder bed, intraoperative drainage must be performed.