22例术后胆漏反思及诊治

Introspection and treatment of bile Ieakage(a report of 22 cases)

目的 反思胆漏形成的原因,探讨诊断及治疗对策。方法 对我院1991年2月至2002年4月收治的22例胆漏病人进行回顾性分析,讨论发生胆漏的原因、诊治策略及效果。结果 10例采用开腹手术,治愈好转9例,1例未愈,治愈好转率90.0％;非手术治疗12例,治愈好转10例,死亡2例,1例死于肝功能衰竭,1例死于胆管癌骨转移,治愈好转率83.3％。结论 胆漏多发生于胆囊切除术后,其次为胆肠吻合、T管拔除后,再次肝创面细小胆管瘘、胃切除等毗邻脏器手术副损伤。术者经验不足、操作不仔细、手术方式选择不当及疾病本身解剖改变是造成胆漏的主要原因。根据胆漏 的不同病因选择单纯腹腔引流、腹腔引流+经内镜鼻胆管引流(ENBD)、腹腔引流+生长抑素、手术重建胆道等措施。

Objective To introspect the causes of bile leakage. To explore the methods of the diagnosis and treatment. Methods 22 patients with bile leakage were treated from Feb.1991 to Mar. 2002 .All the patients were revivewed retrospectively. Results Of the 10 cases treated with operation,9 cases were cured,lease was defeated,The cure and improvement rate was 90.0%, 12 patients received nonoperation, 1 case died of liver failure, ldied of bone mestasiss of the bile cancer, The cure and improvement rate was 83.3%. Conclusion Bile leakage often occurs in cholecystectomy, biliary -enterostomy and removal of a T tube ,The third cause was the small bile leakage in liver surface,The other operations near the bile may result in bile leakage injury, for exemplpe Gastrecto-my etal. The causes of bile leakage are related to abnormality of anatomy,operater's experience,incor-rect manipulation .According to the different caus-es,Four ways were chosen,which were drainage of abdominalocentesis,drainage of abdominalocentesis + ENBD, drainage of abdominalocentesis+somatostain and the reconstruction of bile duct.