胆总管探查后一期缝合胆汁漏的临床分析

Analysis of Bile Leakage after Primary Ductal Closure Following Choledochotomy

目的探讨胆总管探查一期缝合后胆汁漏的发生及其相关因素。方法对我院1999年1月至2003年6月期间,因肝外胆管结石施行胆总管探查后行T管引流的148例和一期缝合的154例患者的临床资料进行分析。结果术后发生胆汁漏T管引流组有11例(7.4%),一期缝合组有16例(10.4%),两组间差异无统计学意义(P>0.05);一期缝合组胆汁漏的发生与高血糖(P<0.05)、低血浆白蛋白(P<0.01)、胆总管多次缝合(P<0.01)及胆汁细菌培养阳性(P<0.05)有关,与高龄无关(P>0.05)。结论严格掌握适应证,认真做好术中特检,轻柔细致的操作以及有针对性的药物治疗,是减少一期缝合胆汁漏发生的关键。

Objective To explore risk factors of bile leakage after primary ductal closure following choledochotomy. Methods A retrospective clinical analysis was made in 148 cases of T-tube drainage and 154 cases of primary common bile duct suture following choledochotomy admitted to our hospital from January 1999 to June 2003. Results Postoperative bile leakage was seen in 11 patients of the group with T-tube drainage and in 16 patients of the group with primary suture respectively, there was no significant difference(P>0.05).In the group with primary common bile duct suture,the occurrence of bile leakage was relative with hyperglycemia(P<0.05),hypoproteinemia (P<0.01),bile duct repeated sutures(P<0.01)and positive bacterial culture in bile(P<0.05). Bile leakage was not relative with elder age (P>0.05).Conclusion It is the key factors,including chosing appropriate patients, intraoperative special examination, careful manipulation and effective medical treatment that can reduce the morbidity of bile leakage.