腹腔镜胆囊切除术后胆囊管瘘的诊断和处理

目的　探讨腹腔镜胆囊切除术 (LC)后胆囊管瘘的诊断和处理方法。方法　回顾性分析 3例LC术后胆囊管瘘病例的临床资料。结果　 3例均为女性 ,因慢性结石性胆囊炎行LC。临床表现分别为原有心律失常的加重 ,腹腔引流管引流出胆汁 ,以及脐部穿刺孔溢出胆汁样液。确定诊断的时间分别是术后第 1天、第 2天和第 2 0天。 2例再次行腹腔镜手术 ,套扎关闭开放的胆囊管 ,腹腔冲洗并引流 ;1例行腹腔穿刺置管引流 ,并经内镜乳头切开及置入胆道支架。 3例均获治愈。结论　LC术后胆囊管瘘临床表现多样 ,B超可以发现腹腔积液 ,确定诊断依赖于MRCP和ERCP。微创手术可以安全有效地处理这一并发症。腹腔镜再手术可以有效地关闭开放的胆囊管 ;内镜下引流的方法要有有效的腹腔引流的配合

Diagnosis and management of cystic duct fistula after laparoscopic cholecystectomy

Objective To evaluate the methods used in the diagnosis and management of cystic duct fistula after laparoscopic cholecystectomy (LC). Methods Retrospective study of the clinical materials of 3 cases of cystic duct fistula after LC was made. Results Three patients were all female and underwent LC for chronic cholecystitis with stones. Their clinical symptoms were worsening of pre-existed cardiac arrhythmia, bile drained out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made on the 1st, 2nd and 20th post-operative day. Two patients were managed under laparoscopy. The opened cystic duct stumps were closed with endo-loop, with the abdomen irrigated and drained. One was drained with percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. Conclusions The clinical manifestations of cystic duct fistula were different. Ascites can be found under B ultrasound. Final diagnosis relies on MRCP and/or ERCP. Minimally invasive techniques can be applied to this complication safely and effectively. Re-operation for closure of the opened cystic duct stump can be fulfilled under laparoscopy. Endoscopic drainage must be accompanied by effective abdominal drainage.