腹腔镜胆囊切除术后迟发性胆漏的特点和防治

Characteristic and prevention of delayed bile leakage after laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术后迟发性胆漏的特点、治疗措施及预防手段。方法对7例腹腔镜胆囊切除术后迟发性胆漏患者的临床资料进行分析。结果该组病例中热电效应引起的胆管穿孔性损伤6例,迷走胆管漏1例,5例行手术治疗,2例经ERCP+ENBD治愈。结论对于手术操作者来说,过多地使用单极高频电钩电凝、电切产生的热电效应,造成损伤的胆管壁组织脱痂、坏死、穿孔,是造成腹腔镜胆囊切除术后迟发性胆漏发生的主要原因,ERCP+ENBD是治疗腹腔镜胆囊切除术后迟发性胆漏的有效手段。

[Objective] To explore the clinical characteristic, prevention and treatment of delayed bile leakage after laparoscopic cholecystectomy. [Methods] 7 cases of delayed bile leakage after laparoscopic cholecystectomy were analyzed retrospectively. [Results] Among the seven cases of delayed bile leakage, six ones were with the result of electrothermal effects which caused perforation of the bile duct, and another one was because of the aberrance of the bile duct. For the treatment, 5 cases received re-operation and 2 cases were controlled by ENBD under ERCP. [Conclusion] Electrothermal effect, which may cause the necrosis and perforation of the bile duct, is technically a main reason of the delayed bile leakage after cholecystectomy. ERCP＋ENBD provide an effective way for controling of the leakage.