肝胆手术后胆漏的原因及处理对策

目的探讨肝胆手术后胆漏的原因及处理对策。方法分析43例肝胆手术后胆漏的原因、处理方法及治疗结果，其中胆囊切除术5例，胆总管探查、T管引流18例，肝叶切除术11例，肝胆管切开取石、胆肠吻合术4例，胆管损伤修复重建2例，肝门胆管癌根治术2例，腹腔镜下肝囊肿开窗引流术I例。结果早期经腹腔充分引流治愈34例，再次手术5例中治愈2例，后遗胆外瘘1例，死亡2例（1例死于肝功能衰竭，另1例死于肾功能衰竭、ARDS）；内镜下鼻胆管引流治愈2例，手术切除窦道治愈1例，经窦道注射硬化剂治愈1例。结论手术操作技术欠缺及对病变部位的认知不足是肝胆手术后胆漏的主要因素．术中精细操作可有效预防术后胆漏的发生，早期有效胆汁引流有利于胆漏痊愈。

The treatment and cause of bile leakage after the hepatobiliary operation

Objective To study the cause and treatment of bile leakage after hepatobiliary operation.Methods 43 cases of bile leakage after hepatobiliary operation were analysed retrospectively, including 5 cases of cholecystectmy, 18 cases of exploration of common bile duct and T tube drainage, 11 cases of hepalobectomy, 4 cases of removing stone and biliary-enteric anastomoses for cholelithiasis, 2 cases of repair and reconstruction for bile duct injury, 2 cases of radical operation for hilar cholangiocarcinoma and one case of laparoscopic fenestration and drainage for hepatic cysts. Results 34 cases were cured by full drainage at early period. Only 2 cases were cured in 5 cases who were accepted reoperation, one suffered from external biliary fistula and the other 2 cases died（one died of hepatic function failure another died of renal failure and ARDS）. 2 cases were cured by endoscopic nasobiliary drainage. One case was cured by sinus tract resection. One case was cured by injection sclerosant for sinus tract. Conclusion The cause of bile leakage after the hepatobiliary operation is related to the undesirable surgical techniques and cognitive deficit. Intraoperative meticulous manipulation may prevent effectively the occecrence of postoperative biliary leakage. Early and effective biliary drainage would contribute to heal biliary leakge.