LC手术所致的胆瘘处理

The Management of Bile Leakage after Laparoscopic Cholecystectomy

目的 探讨预防胆瘘发生和及时发现诊断胆瘘的方法以及处理胆瘘的适宜措施。方法 分析 9例LC相关的胆瘘病例的诊断治疗措施。结果 3例胆瘘经持续引流治愈 ,2例经CT定位穿刺置管引流治愈 ,1例经EST +ENBD治愈 ,手术 3例中 ,2例胆总管T管引流治愈 ,1例经胆总管端端吻合T管引流治愈。结论 胆瘘的发生与Luschka管及副肝管损伤 ,胆囊管残端瘘 ,肝外胆管损伤及LC胆总管探查术后胆瘘等有关。故正确按手术原则和安全操作规程行LC及根据实际情况置放引流管是预防和及时发现胆瘘的措施 ,发生胆瘘需明确部位和性质 ,并根据具体情况行相应的引流管引流 。

Objective To explore the preventive and diagnostic policy and the appropriate treatment in patients with bile leakage following laparoscopic cholecystectomy.Methods The diagnosis and treatment of 9 cases with bile leakage after laparoscopic cholcystectomy were reviewed.Results 3 cases were successfully managed by constant drainage,2 cases were treated by drainged with CT-guided percutaneous puncture. Endoscopic nasobiliary drinage and endoscopic sphincterotomy was done in 1 case. The other 3 cases required surgical corrections. Common bile duct drainage with T tube in 2 cases,and end to end anstomosis of the bile duct with T tube in 1 case were performed.Bile leakage was detected to be related to damage of Luschka's duct,accessory bile duct,cystic duct stump,and extrahepatic duct. It also related to fistula of the common duct following laparoscopic choledochotomy in our clinical data.Conclusion The prevention and early detection of bile leakage are mainly rely on the manipulation of LC and placement of drainage according to the surgical principles and rules. When bile leakage occurs,the location and type of injury must be defined and treated by drainage,endoscopic therapy or laparotomy.