腹腔镜胆囊切除术后非肝外胆管损伤性胆漏的防治

MANAGEMENT OF BILE LEAKING CAUSED BY NON-EXTRAHEPATIC BILE DUCT INJURY UNDER LAPAROSCOPIC CHOLECYSTECTOMY

目的 探讨腹腔镜胆囊切除术 (LC)中非肝外胆管损伤性胆漏的预防及术后的治疗。方法 对 1 6例LC术后非肝外胆管损伤性胆漏的临床资料进行回顾性分析。结果 1例经手术治愈 ,1 5例经非手术治愈。 1 5例(93 75 % )获得随访 ,随访 3个月～ 2年 ,效果优。结论 胆漏的预防主要是对可疑迷走胆管应夹闭 ,胆囊床应普遍电凝 ;胆囊管应牢固夹闭 ,并用剪刀剪断。治疗上有弥漫性腹膜炎者需立即手术治疗 ,否则可行保守治疗。有引流管者 ,保持引流管通畅 ,必要时加用鼻胆管引流 ;无引流管者 ,可在B超引导下穿刺抽液或加用鼻胆管引流。

Objective\ To study prophylaxi and treatment of bile leaking caused by no-extrahepatic bile duct injury in laparoscopic cholecystectomy(LC).Methods\ 16 patients with bile leaking caused by no-extrahepatic bile duct injury in LC were retrospectively analyzed.Result\ 1 case was cured by operation,and the other 15 cases were cured by conservative treatment.15 cases (93.75%) were followed up for 3 months to 2 years.Conclusion\ The key prevention to bile leaking is clip and shear the suspected fascinate bile duct and the cystic duct.The bed of cholecyst should be routinatelly electric coagulated.The cases with diffuse pertonitis should accept emergent operation.Otherwise they can receive conservative treatment.Keeping the drain tube unobstructive.In those cases with no drain tube,puncture and draw fluid with the guidance of BUS or nose-bile duct drainage may be useful.