壶腹周围肿瘤术后胆瘘发生的危险因素及防治

Risk Factors and Prevention and Treatment of Biliary Fistula after Periampullary Tumor Operation

壶腹周围肿瘤术后胆瘘并不多见,一旦出现可能引起腹腔感染、器官功能衰竭,甚至死亡。随着医疗水平的提高,术后胆瘘的死亡率有所下降,但是依然存在。了解导致胆瘘的危险因素,做好围手术期的预防,可减少胆瘘的发生。胆瘘的危险因素主要包括患者的全身状况、胆管局部情况、手术相关因素以及患者疾病情况和术前准备。治疗包括非手术治疗、内镜治疗、介入治疗等,必要时行外科手术治疗。随着材料学的发展,新型胆管缝合线、可降解胆管支架的临床运用,以及手术技巧的不断完善,胆管吻合技术的微创化、精准化,将极大地提高胆瘘手术的安全性及可操作性,进一步降低胆瘘的发生率。

Biliary fistula after periampullary tumor is rare,which may cause abdominal cavity infection,organ failure,and even death once it happens.With the improvement of medical standards,the mortality of postoperative biliary fistula has declined,but it still exists.Understanding the risk factors that lead to biliary fistulas,and good perioperative prevention,can reduce the occurrence of biliary fistulas.The risk factors of biliary fistula mainly include the patient′s general condition,local condition of the biliary tract,operation-related factors,as well as the patient′s disease condition and preoperative preparation.Currently,the main treatment is non-surgical treatment,endoscopic treatment,interventional treatment etc.,and traditional surgical treatment is performed when necessary.With the development of materials science,the clinical application of new biliary sutures and biodegradable biliary stents,as well as the continuous improvement of surgical techniques,the minimally invasive and precise biliary anastomosis technology,the safety of biliary fistula surgery and operability will be greatly improved,and the incidence of biliary fistula can be further reduced.