腹腔镜胆囊切除术后胆漏的临床分析

The Clinical Analysis of Bile Leakage After Laparoscopic Cholecystectomy

目的:对腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)后胆漏进行分析,以期找出问题进而避免。方法:选入本院于2016年7月~2020年7月进行LC术式治疗的患者总计346例,其中选择确诊为胆漏的22例患者,分析胆漏发生因素,并制定解决方法。结果:①22例患者中:72.72%(16/22)为迷走胆管瘘,13.64%(3/22)为胆囊管残端钛夹滑脱胆瘘;13.64%(3/22)为胆囊管残端烧灼后坏死胆瘘;②对22例患者的手术情况分析:有77.27%(17/22)的引流量在100mL以内,经1个月后治疗痊愈出院。其余22.73%(5/22)引流量范围正常。17例引流量<100mL的患者中,1例(5.88%,1/17)术后第5日胆汁减少,1周后腹腔引流管无胆汁流出,10d后痊愈出院;1例(5.88%,1/17)因胆道引流量无减少的情况,在术后半个月经胆道造影,发现管道和右肝管相通,继续引流1个月后痊愈;③对22例患者感染和并发症发生率情况分析:2例并发穿刺出血以及肝下感染的情况,术后第7日无引流物,60d后痊愈出院,其余20例患者均拔管后出院。结论:在手术阶段对胆囊三角的处理要相对仔细,尽可能不要应用电凝钩处理;胆囊床要防止应用地毯式电凝;在胆囊床中发现管状的构造时,要应用合成夹夹闭,不要应用电凝处理。术后通过细致的测定和干预,从而及早规避和治疗。

Objective:Clinical analysis of bile leakage after laparoscopic cholecystectomy in order to find out the problems and avoid them.Methods:A total of 346 patients who underwent LC in our hospital from July 2016 to July 2020 were selected,including 22 patients diagnosed with bile leakage.The factors of bile leakage were analyzed and the solutions were formulated.Results:①Among the 22 patients,72.72%(16/22)were vagal bile duct fistula,13.64%(3/22)were titanium clip slippage bile duct fistula at the stump of cystic duct,and 13.64%(3/22)were necrotic bile duct fistula after burning the stump of cystic duct.②Analysis of the operation of 22 patients:77.27%(17/22)of the drainage volume was less than 100mL,which was cured and discharged after one month of treatment.The other 22.73%(5/22)diversion flow range is normal.Among the 17 patients with drainage volume<100mL,1 case(5.88%,1/17)had decreased bile on the 5th day after operation,no bile outflow from the abdominal drainage tube after 1 week,and 1 case(5.88%,1/17)was cured and discharged after 10 days Because there was no decrease in biliary drainage,it was found that the pipeline was connected with the right hepatic duct by cholangiography half a month after operation,and recovered after continuous drainage for 1 month.③Analysis of the incidence of infection and complications in 22 patients:2 patients complicated with puncture bleeding and subhepatic infection had no drainage on the 7th day after operation,recovered and discharged after 60 days,and the other 20 patients were discharged after extubation.Conclusion:In the operation stage,the treatment of gallbladder triangle should be relatively careful,and electrocoagulation hook should not be used as much as possible;Carpet electrocoagulation should be prevented in the gallbladder bed;when tubular structures are found in the gallbladder bed,synthetic clamp should be used instead of electrocoagulation.After operation,careful measurement and intervention should be carried out to avoid and treat them as soon as possible.