急诊胆道手术后胆漏的原因及处理

Causes and managements of bile leakage after emergency operation on biliary tract

目的 探讨急诊胆道手术后胆漏的原因及处理方法。方法 回顾分析我科 1998- 0 1～ 2 0 0 3- 12急诊胆道手术后 17例胆漏的原因和治疗方法。结果 17例胆道术后胆漏中 ,13例为胆总管缝合处胆漏 ,2例为T形管部分脱出胆总管 ,1例为胆总管与十二指肠汇合部胆漏合并肠漏 ,1例可能为胆囊切除后所致副肝管损伤。 16例经保守治疗后治愈 ,1例经再手术治疗后死亡。结论 正确的手术时机和手术方法、轻柔的操作是预防急诊手术后胆漏的关键 ,通畅的腹腔引流、严密的观察。

Objective To investigate the causes and managements of bile leakage after emergency operation on biliary tract. Methods To retrospect the causes and managements of bile leakage in 17 cases after emergency operation on biliary tract from January 1998 to December 2003 in our department. Results The biles leaked from the common bile duct suture in 13 cases, T tubes got out of the common bile duct partly in 2 cases. Bile leakage combining with intestine leakage located at the convergence of the common bile duct and duodenum in 1 case and the accessory hepatic duct was likely impaired after cholecystectomy in 1 case. 16 cases were healed by conservative therapy, 1 case died after reoperation. Conclusion Correct operation opportunity and approach, gentle operation are the keys to prevent the bile leakage. Unobstructed drainage, exact observation and choosing correct treating approach are the important guarantee for the treatment of the bile leakage after emergency operation.