LC术后胆囊床毛细胆管漏的原因及处理对策

STUDY ON THE CAUSATION,TREATMENT AND COUNTERMEASURES OF CAPILLARY BILE LEAKAGE IN GALLBLADDER BED AFTER LAPAROSCOPIC CHOLECYSTECTOMY

目的探讨LC手术后胆囊床毛细胆管漏的原因及处理对策。方法回顾性分析我院1992年10月~2009年7月共施行的LC术71238例,其中发生胆囊床毛细胆管胆漏75例的临床资料。结果本组75例中,造成胆囊床毛细胆管漏的主要原因是胆囊急性炎症、萎缩性胆囊炎及胆囊床电凝过深等引起。46例给予腹腔引流等保守治疗,17例行内镜鼻胆管引流（ENBD）,12例手术治疗,治愈率达100%。结论 LC手术后胆囊床毛细胆管漏最直接原因是医疗行为过程中操作不当、判断失误而造成。关键在于预防,处理方式视病情而定。

Objective To explore the causation,treatment and countermeasures of capillary bile leakage in gallbladder bed after laparoscopic cholecystectomy.Methods The clinical data of 75 cases which occur capillary bile leakage in gallbladder bed among 71238 cases LC were analyzed retrospectively from October 1992 to July 2009.Results Among the 75 patients,the gallbladder acute inflammation,atrophic cholecystitis and deeper cut of gallbladder bed is the main reason of capillary bile leakage in gallbladder bed.46 cases were healed by celiac drainage and conservative treatment,17 cases were healed by ENBD,12 cases were healed by open surgery,the cure rate was 100%.Conclusion Improper operation in medical behavior process and errors in judgment is the most direct reason of capillary bile leakage in gallbladder bed,the key lies in the prevention,and according to the patient′s condition choose corresponding operation mode.