肝切除术后胆漏的预防与处理

The prevention and treatment of bile leakage after the hepatectomy

目的探讨肝切除术后胆漏的预防与处理。方法分析近4年行肝切除术384例,发生胆漏14例,其中原发性肝癌7例,胆囊癌2例,肝血管瘤1例,肝胆管结石3例,肝外伤1例。结果胆漏发生率为3.6%,经充分引流治愈10例,行内镜下胆管支架引流或鼻胆管引流治愈2例,再手术2例,其中1例死于术后肝功能衰竭。结论术中精细操作可有效预防肝切除术后胆漏的发生。充分引流、抗感染和营养支持可有效治疗胆漏,对引流量大者可行内镜下胆管支架引流或鼻胆管引流,尽量避免早期再次手术。

Objective To study the prevention and treatment of bile leakage after hepatectomy. Methods 384 cases of hepatectomy were analysised, 14 cases suffered bile leakage, who including primary liver cancer 2, gallbadder cancer 2, hepatic hemangioma 1, calculus of hepatic biliary duct 3 and hepatic trauma 1. Results The incidence of bile leakage was 3.6 %. 10 cases were cured by full drainage, 2 cases were cured by endoscopic stent insertion or nasobiliary drains, 2 cases accepts reoperation and one died of hepatic function failure. Conclusion Careful procedure can prevent the bile leakage after hepatectomy. Full drainage, anti - infection and nutritional support may cure the bile leakage. Endoscopic stent insertion or nasobiliary drains are safe and effective in some patients with huge leakage. Early reoperation should be avoided.