肝切除术后胆漏的处理

Management of bile leakage after hepatic resection

目的探讨肝切除术后胆漏的发生及处理。方法回顾性分析441例无胆道重建肝切除术后胆漏的发生情况和处理方式。结果441例肝切除后出现胆漏21例，发生率为4．8％，其中原发性肝癌11例，转移性肝癌1例，肝脓肿2例，肝血管瘤2例，肝胆管结石5例。经腹腔充分引流治愈12例，行内镜下胆管支架引流或鼻胆管引流治愈6例，再手术2例，1例死于术后肺部感染和腹腔感染。结论经腹腔充分引流或鼻胆管引流和胆管支架置入可有效治疗胆漏，尽量避免早期再次手术。

Objective To study the incidence and management of bile leakage after hepatic resection. Methods The incidence and management of bile leakage after hepatectomy in 441 patients were analysed retrospectively. Results Twenty - one patients suffered with bile leakage and the incidence was 4. 8% ,in which, 11 cases of primary liver cancer, 1 case of metastatic liver cancer, 2 cases of liver abscess, 2 cases of hepatic hemangioma and 5 cases of hepatolithiasis. Twelve cases were cured by full drainage, 6 cases were cured by nasobiliary drains or endoscopic stent insertion, 2 cases accepts reoperation and I case died of severe postoperative sepsis. Conclusions Full percutaneous drainage of bile with or without endoscopic biliary decompression are primary and effective interventions in the management of most cases of bile leakage after hepatectomy. Early reoperation should be avoided.