腹腔镜胆囊切除术并发胆漏7例处理体会

目的 探讨腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）并发胆漏的原因及处理方法.方法 对我院普外科2011年1月～2012年12月行腹腔镜胆囊切除术938例中并发胆漏7例患者的临床资料进行回顾分析.结果 7例中3例为术中发现胆漏,4例为术后1-4天发现胆漏;胆总管或肝总管损伤3例,Luschka胆管漏2例,另2例胆漏原因未明确,考虑1例为胆囊管残端漏,1例为胆囊床毛细胆管漏;7例均治愈.结论 熟悉胆囊局部解剖及变异,术中仔细观察,不粗暴操作,可有效预防或及时发现胆漏并进行处理,以微创方式行外引流术是解决LC术后胆漏的有效方法.

Experience in treatment of 7 cases Bile leakage associated with laparoscopic cholecystectomy

Objective To investigate the reasons and treatment of bile leakage associated with laparoscopic cholecystectomy. Methods The clinical data of 7 bile leakage cases of 938 patients who underwent LC from Jan. 2011 to Dec. 2012 in the general sur- gery department of our hospital were retrospectively analyzed. Results 3 of 7 bile leakage were detected in intraoperative and 4 of them were diagnosed post-laparoseopic eholecystectomy from 1 to 4 days. Common bile duct injuries in 2 and common hepatic duct in- juries in 1. 2 cases were duct of Lusehka leaks and the reason of leaks in other two cases were indeterminacy, one was considered as cystic duct stump leakage and the other one was capillary bile leakage in gallbladder bed. 7 patients were cured. Conclusion It can prevent the occurrence of bile leakage during LC or can detect it early for correct treating that know well about local anatomy and varia- tion of gallbladder, keep under observation, no rough operation. Minimally invasive drainage is usually effective in treatment of bile leakage after LC.