腹腔镜胆总管切开取石一期缝合术后胆汁漏18例临床分析

Clinical analysis of 18 cases of bile leakage after laparoscopic choledo-chotomy and primary suture

目的探讨腹腔镜胆总管切开取石一期缝合术后胆汁漏的原因及预吩措施。方法收集2013年1月一2017年12月在中国人民解放军联勤保障部队第904医院肝胆外科及宁夏回族自治区人民医院肝胆外科住院行腹腔镜胆总管切开取石一期缝合的患者,共计328例,其中术后出现胆汁漏的患者共计18例,对其临床资料进行回顾性分析。结果18例患者造成术后胆汁漏的原因主要与年龄、糖尿病、低蛋白血症、胆管壁薄弱、取石时间过长、oddi's括约肌水肿、缝线选择不当有关(P<0.05),而与性别及胆管粗细无关(P>0.05)。其中,12例患者经常规引流、预防腹腔感染、肠外营养等保守治疗,6例患者行腹腔穿剌引流治疗,均治愈。结论严格掌握手术适应证,加强围手术期管理,合理选择缝线,提高手术及胆道镜操作技术,是预防腹腔镜胆总管一期缝合术后胆汁漏的主要措施,术中再次探查确定胆管情况十分必要。对于术后胆汁漏不局限的患者,应及时行腹腔穿刺引流。

Objective To discuss the causes and preventive measures of bile leakage after laparoscopic choledochotomy and primary suture.Methods From January 2013 to December 2017,328patients how underwent in the two hospitai of laparoscopic choledocholithotomy and primary suture in the Department of hepatobiliary surgery of Chinese peopled Liberation Army 904 Hospital and people's Hospital of the Ningxia Hui Autonomous Region,including 18 patients who had bileleakage after operation the clinical data were analyzed retrospectively.Results The causes of postoperative bile leakage in 18 patients were mainly related to age,diabetes,hypoproteinemia,bile duct wall weakness,stone extraction time too long,Oddi's sphincter edema and inappropriate suture selection(P<0.05),but not related to gender and bile duct thickness(P〉0.05).Among them,12 patients were treated with regular drainage,prevention of abdominal infection,parenteral nutrition and other conservative treatment;6 cases were treated with abdominal puncture and drainage,all cured.Conclusion Strictly controlling surgical indications,strengthening perioperative management,rationally selecting sutures and improving operative techniques and bile duct operation techniques are main measures to prevent bile leakage after laparoscopic common bile duct primary suture.It is very necessary to detect bile duct again during operation.The patients with postoperative bile leakage should be punctured by abdominal puncture and drainage in time.