内镜下胆道内支架防治创伤性肝破裂术后胆漏*

目的探讨内镜下胆道内支架在防治创伤性肝破裂术后胆漏中的价值。方法回顾性分析2000年1月-2014年9月该院收治的42例创伤性肝破裂术后胆漏患者的临床资料,分为手术组和支架组,手术组10例常规行手术治疗,支架组32例行胆道内支架引流治疗,评估胆道内支架在创伤性肝破裂术后胆漏防治中的应用价值。结果研究中发现3种胆漏类型:肝实质胆漏31例,胆总管胆漏9例,T管窦道漏2例。支架组Sandha胆道造影分型:Low grade型11例,High grade型21例。支架组再手术率、并发症率明显少于手术组,差异有统计学意义(χ~2=4.09,P0.05;χ~2=4.44,P0.05);支架组住院时间明显短于手术组,差异有统计学意义(t=3.71,P0.05)。两组在治疗前后的炎症指标有差异。胆道内支架移除时间5~15个月,平均(7.2±2.2)个月。结论内镜逆行性胰胆管造影术(ERCP)能精确诊断胆漏,ERCP胆道内支架可作为严重创伤性肝破裂术后胆漏(评分高、胆漏量大或合并狭窄)的首选治疗方法。

Endoscopic biliary internal stents for postoperative bile leaks after traumatic rupture of liver*

  Abstract: Objective To evaluate the value of endoscopic biliary internal stents (ERBD) for bile leaks after traumatic rupture of liver. Methods A retrospective study was performed in 42 patients with bile leaks after surgery of traumatic rupture of liver from 2000 to 2014. We divided all patients into two groups: operation group who took operative treatment and stents group who took biliary internal stents. We assessed the value of biliary internal stents in the bile leaks after traumatic rupture of liver. Results We discovered three types of bile leaks: The liver parenchyma bile leaks: 31, the common bile duct bile leaks: 9, the T duct bile leaks: 2. According to the Sandha classification, we classified the patients into 11 low grade and 21 high grade. The difference of reoperation rate and complication rate between the groups had statistical significance (χ2 = 4.09, P < 0.05; χ2 = 4.44, P < 0.05). Similarly, the difference of hospitalization time after the two treatments had significant statistical significance (t = 3.71, P < 0.05). The two treatments also had differences between inflammatory indexes and liver function before and after treatment. The time of stents'' removal was (7.2 ± 2.2) months. Conclusion The ERCP can diagnose the bile leaks accurately, the endoscopic biliary internal stents can be used as the preferred treatment for severe traumatic hepatic rupture (high grade, high flow capacity, or combine with stricture).