胆道手术后胆瘘的原因分析及治疗

Cause and treatment of biliary fistula after bile duct surgery

目的:探讨胆道手术后发生胆瘘的原因及其预防与治疗。方法:回顾性分析胆道手术后发生胆瘘23例患者的临床资料。结果:术后发生胆瘘的原因为肝床毛细胆管或细小副肝管损伤11例,肝管损伤或坏死2例,胆囊管残端瘘1例,拨T管后胆瘘6例,T管早期脱落2例,T管安置不当1例。保守治疗14例(60.9%),再手术治疗9例(39.1%),均痊愈出院。结论:胆瘘多发生于胆囊切除术、胆道手术及拨T管后,主要原因与肝床毛细胆管或细小副肝管损伤、胆道损伤、局部炎症和操作不当等有关。胆瘘发生后应根据腹膜炎的轻重,有无胆道梗阻以及腹腔引流是否通畅等选择保守治疗或再手术治疗。

Objective：To investigate the cause, prevention and treament of biliary fistula after biliary tract surgery. Methods ： The clinical data of 23 patients with biliary fistula after bile duet surgery at Yanliang hospital from 1990 to 2004 were reviewed. Results： Cause of biliary fistula included injury of liver bed cholangioles or tiny accessory hepatic duct in 11 cases, injury or putrescence of hepatic duct in 2, stump leakage of cystic duct in 1, After T-tube removement in 6, early T-tube inadvertent sliding off in 2, Out of place of T-tube in 1. Fourfeen patients underwent conservative therapy （60. 1%） and nine reoperation （39. 1%）. All patients were cured. Conclusion： Biliary fistula often occars after cholecystectomy or bile duct surgery, and after the removal of T-tube. Conservative therapy is often successful unless there is a frank peritonitis , bilary tract obstruction or improper peritoneal drainage.