腹腔镜胆囊切除术后胆漏原因及处理

目的探讨腹腔镜胆囊切除术(LC)术后胆漏的原因及诊治对策。方法回顾分析我院1992年5月至2005年7月收治的LC术后胆漏12例的临床资料。结果本组胆道损伤率为0.73%(25/3408),表现为术后胆漏的占36%(9/25)。其中主胆管损伤5例,副肝管损伤7例,除1例迷走胆管损伤未行再手术外,其余11例均再手术,均治愈。结论术后胆漏是LC胆道损伤的特点之一,LC术后不明原因的突发性上腹部剧痛是胆漏的信号。胆漏量<100ml/d,可行B超引导下穿刺置管引流;胆漏量>100ml/d,应及时开腹再手术,根据情况行胆道的修复或重建,若不能行一期修复或重建的可先行经近端胆管插管外引流。

The causes and managements of the bile leakage after laparoscopic cholecystectomy

Objective To investigate the causes,diagnosis and treatments of bile leakage after laparoscopic cholecystectomy (LC).Methods A retrospective clinical analysis was made on 12 patients with bile leakage after LC who were surgically treated in our hospital from May 1992 to July 2005.Results The rate of bile leakage accounted for 0.73% (25/3 408)36% (9/25) of them were representative of postoperative bile leakage.Among 12 cases of bile leakage,there were 5 cases of general liver duct injuries and 7 cases of vice liver duct injuries.All cases were re-operated except the case of the aberrant bile duct injured.All of the cases were cured.Conclusion Postoperative bile leakage is one of the characteristics of bile duct injure during LC.It is a signal of bile leakage that a sudden upper abdominal pain happens but the reason is unknown after LC.Abdominal drainage under the guide of B ultrasound is done if the volume of bile leakage is less than 100ml/day.Otherwise,an exploratory celiotomy is carried out for repairing or re-building the injured bile duct if the volume of bile leakage is more than 100ml/day.We can give an out-drainage by placing a duct into the approaching bile duct if the bile duct injuries could not be repaired or re-built in one operation.