腹腔镜胆总管探查术后拔除T管出现胆漏的诊治分析

Diagnosis and treatment of biliary leakage caused by T tube extraction after laparo-scopic bile duct exploration

目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后拔除T管出现胆漏的诊治。方法回顾性分析我院2016年7月至2021年12月实施的LCBDE共1062例,其中919例留置T管,术后T管拔除时间为43~102 d,平均拔除时间82 d,拔除T管后9例(0.9%)出现胆漏,分析归纳9例患者的临床资料。结果5例经窦道放置引流管,2例经窦道放置引流管联合腹腔穿刺引流,1例经窦道放置引流管并行腹腔穿刺引流联合内窥镜鼻胆管引流(endoscopic nasobiliary drainage,ENBD)引流;1例经窦道放置引流管联合ENBD引流,9例患者均治愈,平均住院天数22 d。结论LCBDE后拔除T管出现胆漏不能完全避免,且原因复杂,发生胆漏后可采用微创治疗,如放置窦道引流管、B超引导下腹腔穿刺引流、ENBD等,效果满意。

Objective To investigate the diagnosis and treatment of bile leakage after removal of T tube after laparoscopic common bile duct exploration(LCBDE).Methods A total of 1062 cases of LCBDE performed in our hospital from Jul.2016 to Dec.2021 were retrospectively analyzed,among which 919 cases were indwelled with T tube,and the postoperative TIME of T tube removal was 43-102 days,with an average of 82 days.After the removal of T tube,9 cases appeared biliary leakage,accounting for 0.9%.Clinical data of the above cases were analyzed and summarized.Results Drainage tube was placed through sinus passage in 5 cases,drainage tube was placed through sinus passage combined with peritoneal puncture drainage in 2 cases,drainage tube was placed through sinus passage combined with peritoneal puncture drainage combined with endoscopic nasobiliary drainage(ENBD)drainage in 1 case.One patient was placed with drainage tube and ENBD drainage through the sinus tract,and all 9 patients were cured,with an average hospital stay of 22 days.Conclusion Removal of T tube after LCBDE can not completely avoid biliary leakage and the reasons are complicated.Minimally invasive treatment,placement of sinus drainage tube,abdominal puncture drainage guided by B ultrasound,ENBD,etc.can achieve satisfactory results.