腹腔镜胆囊切除术后胆漏的原因及处理

目的：探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC)术后胆漏的诊治预防措施。方法：对本1991年3月－2001年5月9267例LC术后发生胆漏31例（0．33％）的原因进行回顾和分析。结果：全部治愈，18例经过非手术治疗，占58％，13例行再次腹腔镜探查或开腹探查手术，占42％。结论：严格掌握腹腔镜胆囊切除手术适应证，沿胆囊壶腹向下分离，仔细辨别Calot三角剖结构，采取顺行和（或）逆行结合、适时把握中转开腹手术的时机是预防胆漏等并发症的关键。

CAUSES AND TREATMEMT OF BILIARY FISTULA AFTER LAPAROSCOPIC CHO LECYSTECTOMY

Objective To study the diagnosis and precaution of biliary fistula after Laparoscopic holecystectomy.Methods Review and analyse 36(58%) patients of biliary fistula among 9 267 cases who underwent LC from March,1991 to May,2001.Results 36 patients had healed.Eighteen(58%) cases healed without operation;thirteen(42%) cases underwent laparoscopic agian and laparotomy.Conclusion It must grasp indication of Laparoscopic Cholecystectomy strictly,separate gallbladder ampullae downword,distinguish anatomical structure of calot trigone carefully combine the direct and/or retrogradation method.It is the key step of grasping proper occasion of transfer to laparotomize.It is the key step to prevent complications such as biliary fistula,too.