腹腔镜胆囊切除术后胆漏的原因及对策

目的探讨腹腔镜胆囊切除术后胆漏的原因、预防方法及处理措施。方法对 12 0 0 0例腹腔镜胆囊切除术后 34例明确病因的胆漏患者的临床资料进行回顾性分析。结果本组患者胆总管横断损伤 6例 ,经胆总管空肠Roux en Y吻合术治愈 ;胆囊管残端钛夹脱落 3例 ,经重新结扎胆囊管残端治愈 ;胆总管及右肝管侧壁损伤 7例 ,经胆总管修补、“T”管支持引流治愈 ;2 1例迷走胆管或副肝管损伤均经保守治疗治愈 ;3例患者出现膈下脓肿 ,经理疗、多次B超导向下穿剌抽液治愈 ;1例胆总管空肠Roux en Y吻合术后出现胆肠吻合口狭窄 ,再手术治愈。结论肝外胆管、迷走胆管损伤及胆囊管残端钛夹脱落是腹腔镜胆囊切除术后胆漏的主要原因 ,建立通畅的腹腔引流 ,行胆总管修补、“T”管支持引流或胆肠吻合是治疗腹腔镜胆囊切除术后胆漏、预防并发症出现的主要方法。

The cause of and management for bile leakage after laparoscopic cholecystectomy

Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.