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目的　探讨胆道手术后发生胆漏的原因及其预防与治疗方法。方法　对浙江省平湖市中医院 1994~2003年间胆道术后发生胆漏的 28例临床资料作回顾性分析。结果　术后发生胆漏的原因为肝床毛细胆管或细小副肝管损伤 15例,胆总管癌切开探查后胆漏 1例,胆囊管残端漏 1例,T管早期滑脱或拔T管后胆漏 10例,T管引流术后护理不当 1例。保守治疗 21例(75% ),再手术 7例 (25% ),除 1例胆管癌晚期自动出院外其余均痊愈出院。结论　胆漏多发生于胆囊切除术、胆道手术及拔T管后,主要原因与肝床毛细胆管或细小副肝管损伤、局部炎症和操作不当等有关。胆漏发生后应根据腹膜炎的轻重,有无胆道梗阻以及腹腔引流是否通畅等选择保守治疗或再手术治疗。

Causes and treatment of biliary fistula after bile duct surgery:report of 28 cases

Objective To investigate the cause,prevention and treatment of biliary fistual after biliary tract surgery.Methods The clinical data of 28 patients with biliary fistula a fter bile duct surgery at Pinghu Traditional Chinese Medicine from 1994 to 2003 were reviewed. Results Cause of biliary fistula included injury of liver bed cholangioles or tiny accessory hepatic duct in 15 cases,biliary fistula after in cision and exploration of common bile duct in biliary duct cancer in 1,stump lea kage of cystic duct in 1,early T-tube inadvertent sliding off or after T-tube removement in 10.Twenty-one patients underwent conservative therapy (75%) and 7 reoperation (25%).Fistula was cured in 27 cases,while the remaining one who su ffered from late staged bile duct cancer died.Conclusion Biliary fistula often occurs after cholecystectomy o r bile duct surgery,and after the removal of T-tube.Conservative therapy is oft en successful unless there is a frank peritonitis,biliary tract obstruction or i mproper peritoneal drainage.