腹腔镜处理腹腔镜胆囊切除术后胆漏的诊治体会

Diagnosis and treament of biliary leakage after laparoscopic cholecystectomy by laparoscopy

目的探讨腹腔镜处理腹腔镜胆囊切除术后胆漏的原因及防治方法。方法对12例腹腔镜胆囊切除术后胆漏患者的临床资料诊治进行回顾性分析。结果4例患者经非手术治疗痊愈;8例经再次行腹腔镜探查术,其中胆囊管残端钛夹脱落或夹闭不全4例,经重新结扎胆囊管并置腹腔引流后治愈;肝外胆管撕裂伤2例,经腹腔镜下缝合修补置腹腔引流治愈;迷走胆管损伤致胆漏者1例,采用钛夹夹闭治愈;胆囊切除加胆总管切开取石胆总管一期缝合针眼渗漏胆汁1例,拆除胆总管缝线置"T"管引流,一个月后拔除"T"管治愈。结论胆囊管残端钛夹脱落或夹闭不全、肝外胆管或迷走胆管损伤是腹腔镜胆囊切除术后胆漏的主要原因,若腹腔引流通畅,无腹膜炎体征,引流胆汁每日不超过200ml并逐日减少可经非手术治疗治愈,其他可再次行腹腔镜探查予以处理,但关键还在于预防。

Objective To investigate the cause and treatment of biliary leakage after laparoscopic cholecystectomy by laparoscopy. Methods The clinical data of 12 cases with biliary leakage in this hospital were retrospectively reviewed and analyzed. Results 4 cases were recovered after conservative treatment. The remaining 8 cases received laparoscopic approach again. The falling off or insufficient grip of clip at stump of ductus cysticus in 4 cases was treated by ligation of ductus cysticus. Laceration of extrahepatic bile duct in 2 cases was treated by suturation. Biliary leakage caused by aberrant duct in 1 case was treated by gripping with clip. The pinhole leakage in 1 case was treated by T - tube stentiug. Conclusion Falling off of clip and injury in bile duct are the most common causes for biliary leakage after laparoscopic cholecystectomy. Cases with patent drainage without physical signs of peritonitis and their amount of bile drainage less than 200 ml per day can be treated by conservative treatment. The remaining cases may be treated with laparoscopic approach. The key point for preventing biliary leakage in laparoscopic cholecystectomy is by taking prophylactic measures during the operation.