十二指肠镜在诊治胆管术后胆汁漏中的应用

The application of duodenoscopy in the diagnosis and treatment of bile leakage after biliary operation

目的探讨应用十二指肠镜诊断及治疗胆管术后胆汁漏的价值。方法 2002年1月～2008年7月,应用十二指肠镜诊治胆管术后胆汁漏患者43例,先通过ERCP明确胆汁漏类型,然后根据胆汁漏的具体类型进行针对性治疗,对治疗效果进行分析。结果 43例患者中,胆囊管残端漏34例,损伤性胆管漏8例,迷走胆管漏1例。所有患者均通过十二指肠镜明确诊断,3例胆管严重损伤转行开腹手术,其余40例进行了内镜治疗,38例痊愈,治疗成功率为88.37%(38/43),术后无严重并发症发生。结论针对胆管术后胆汁漏,十二指肠镜是一种微创、安全、有效的诊断和治疗方法,使多数患者免受开腹手术之苦。

【Objective】To explore the value of duodenoscopy in the diagnosis and treatment of bile leakage after biliary operation.【Methods】From January 2002 to July 2008,totally 43 patients with biliary postoperative bile leakage were referred for endoscopic retrograde cholangiopancreatography（ERCP） and received suitable therapies according to the special conditions of bile leakage.The success rate and postoperative results were observed and analyzed.【Results】In this study,43 cases were correctly diagnosed by ERCP.ERCP revealed bile leakage from the cystic stump in 34 cases,from the biliary duct in 8,from the aberrant biliary duct in 1.Three cases of serious biliary duct injury received open surgery after diagnostic ERCP,the other 40 patients were underwent the correspongding endoscopic therapy according to the outcomes of ERCP and cured in 38.The overall success rate was 88.37%（38/43）.There were no serious postoperative complications.【Conclusions】ERCP is recommended as a safe and efficacious intervention to diagnose and treat bile leakage after biliary operation.Most of patients with postoperative bile leakage may avoid unnecessary laparotomy through duodenoscopic treatment.