鼻胆管引流治疗胆囊切除术后胆漏

目的:探讨经内镜逆行胰胆管造影(ERCP)和经内镜鼻胆管引流(ENBD)在胆囊切除术后胆漏诊治中的应用价值。方法:对胆囊切除术后有腹痛、发热、B超引导穿刺引流出胆汁而诊断为胆漏的患者进行ERCP检查,并行ENBD。结果:15例患者ERCP检查均成功,10例发现有造影剂漏出,其中2例伴有明显胆管损伤,2例合并有胆总管结石。除2例胆管损伤患者接受手术治疗外,其余13例均经ENBD治疗成功,2例胆总管结石患者成功接受了EST网篮取石术。结论:对于胆囊切除术后出现胆漏的患者,ERCP是理想的诊断方法,而且还可以通过ENBD结合腹腔引流得到有效治疗。

Treatment of Postcholecystectomy Bile Leakage by Endoscopic Nasobiliary Drainage

Objective:To study the efficacy of endoscopic retrograde cholangiopan creato graphy(ERCP)and endoscopic nasobiliary drainage(ENBD)in the diagnosis and therapy of bile leakage after cholecystectomy.Methods:ERCP and ENBD were performed in all the patients who had abdominal pain and fever or percutaneous drainage of bile under ultrasound guidance after cholecystectomy.Results:ERCP and ENBD were successful in all the 15 patients.The presence of bile leaks was confirmed by ERCP in 10 patients,major ductal injury in 2 patients,residual stones in 2 patients.Bile leakage was treated successfully in 13 patients with no further complications and 2 patients were treated surgically because of major ductal injury.Residual stones were seen in the common bile duct in 2 patients,sphincterotomy was followed by stone extraction using dormia basket.Conclusion:ERCP is recommended as a safe and efficacious intervention to detect and treat bile leakage after cholecystectomy.ENBD and percutaneous drainage of abdominal collections can cure postcholecystectomy bile leakage.