腹腔镜胆总管探查取石术后T管相关的胆漏原因分析

Technical difficulties and countermeasures of placing T tube during laparoscopic common bile duct explo-ration

目的：探讨腹腔镜胆总管探查取石术（laparoscopic common bile duct exploration, LCBDE）治疗胆总管结石中放置 T 管不当所致的并发症和处理措施。方法2010年5月至2013年10月完成的368例 LCBDE,其中15例 T 管放置后出现胆漏。回顾性分析该15例临床治疗,分析探讨胆漏的原因及相对应的处理。结果胆漏均与 T 管的放置、缝合不当有关,14例病人经过保守治疗后治愈,1例二次手术。结论腔镜下 T 管的放置有较高的技术难度,选择合适的 T 管、合理的剪裁与放置、恰当的缝合胆总管切口是避免胆瘘发生的重要措施。

Objective To explore the technical difficulties and countermeasures of placing T tube during laparoscopic common bile duct exploration （LCBDE）.Methods From May 2010 to October 2013,a total of 368 cases of LCBDE were performed.And 15 cases had a postoperative onset of bile leakage.Their clinical data were analyzed retrospectively to seek the causes and countermeasures.Results Bile leakage was associated with T tube placement and improper suturing.One case was reoperated while the remainder was cured after conservative measures.Conclusions Laparoscopic tube placement carries high technical difficulties.And selecting an appropriate T type tube,rational tailoring and placing and proper suture of bile duct incision are essential for preventing the occurrence of bile leakage.