胃癌根治术后胆瘘7例临床分析

【摘要】 目的 探讨胃癌根治术后胆瘘的病因、临床表现、诊断及治疗方法。方法 对7例胃癌根治术后胆瘘患者的临床资料进行回顾性分析。 结果 7例患者确诊为胆瘘的时间分别为:术后第3、4天各2例,术后第6、7、10天各1例。7例患者均出现右上腹部不同程度的疼痛、心动过速(HR>120 bmp)、发热(体温>38.5℃)和血白细胞升高(WBC计数>15×109/L)。7例患者中有6例经保守治疗后3~8周治愈,另1例经再次手术引流8周后治愈。结论 术中胆总管损伤是导致胃癌根治术后胆瘘的主要原因,术后早期诊断、充分的引流是保证术后胆瘘治愈的关键。

Clinical analysis of 7 case of biliary fistula after radical resection of gastric cancer

Objective To investigate the etiology, clinical manifestations, diagnosis and treatment of the biliary fistula after radical resection of gastric cancer. Methods The clinical data of seven patients with biliary fistula after radical gastrectomy were retrospectively analyzed. Results Two patients were found biliary fistula symptoms in the third day after surgery and two case appeared in the fourth day. The other trree patients were found biliary fistula in sixth, seventh and tenth, respectively day after surgery. All seven patients were appeared right upper quadrant pain in varying degrees, tachycardia （ HR〉 120 bmp）, fever （body temperature〉38.5 ~C ） and elevated blood leukocyte （WBC eount〉lSxlOg/L）. Six of 7 patients were cured by conservative treatment in three to eight weeks, and another one patients were cured after reoperation drainage of 8 weeks. Conclusion Intraoperative common bile duct injury is the main cause of biliary fistula after the radical resection of gastric cancer. Postoperative early diagnosis and adequate drainage is the key to cure the biliary fistula after radical resection of gastric cancer.