胆囊切除术后近期黄疸的预防和处理

The strategy of prevention and management for the early jaundice following cholecystectomy

目的 :探讨胆囊切除术后近期黄疸的预防和处理对策 ,提高对胆囊切除术后近期黄疸的认识。方法 :回顾总结分析 112 2 6例开腹单纯胆囊切除术后一周内发生黄疸的 4 3例临床资料。结果 :手术后一周内出现黄疸共 4 3例 ,占同期开腹胆囊切除术的 0 .4 %。其中内科性黄疸 18例 ,外科性黄疸 2 5例。经BUS、ER CP、MRCP、肝酶谱及再手术等证实 :肝外胆管或右肝管结扎 9例 ,胆总管遗漏结石 6例 ,残留胆囊或胆囊管结石 4例 ,胆漏 4例 ,毛细胆管肝炎 4例 ,乙肝或肝炎后肝硬化 5例 ,输血后黄疸 2例 ,胆道出血 2例 ,肝右动脉结扎 2例 ,不明原因黄疸 5例。再手术 18例 ,死亡 1例。结论 :详细的病史资料、充分的术前检查、细致的手术操作是预防胆囊切除术后近期黄疸的必要前提。

Objective:To enhance the awareness to the early jaundice following cholecystectomy.Methods:A prospective study comprising 11226 consective patients undergone open cholecystectomy from 1986.1 to 2000.12 was performed.Results:The early jaundice of postcholecystectomy occured in 43 patients(0.4%),in whom 18 cases were medical jaundice and 25 cases surgical jaundice. By B type ultrasound scans;CT scans;ERCP;MRCP;re operation and liver function tests,the early jaundice following cholecystectomy involoved common bile duct or right bile duct ligation(9 cases),remaining stones in common bile duct(6 cases),remaining gallbladder duct stones(4 cases),bile fistule(4 cases),intrahepatic cholestasis(4 cases),hepatitis B or cirrhosis(5 cases),posttransfusion(2 cases),hemobilia(2 cases),right hepatic artery ligation(2 cases),unknown causes jaundice(5 cases). 18 patients were re operated,one patient died.Conclusion:The early jaundice presenting after cholecystectomy may be prevented by comprehensive patients history、ample preoperative examination and careful operative manipulation;the management must depend on the different causes of jaundice.