胆道手术后胆漏20例临床分析

Clinical analysis of 20 cases with postoperative biliary leakage

目的 探讨胆道手术后发生胆漏的原因及其预防和治疗的措施。方法 对 1997～ 2 0 0 2年间胆道手术后发生胆漏的 2 0例患者的临床资料进行回顾性研究。结果 2 0例发生胆漏原因为肝床胆管或细小副肝管损伤 7例、拔T管后胆漏 6例、T管周围胆漏 3例、T管早期滑脱和T管不慎拽出各 1例、胆道损伤 1例、胆囊管残端结扎线脱落 1例。本组保守治疗 16例 ( 80 % ) ,再手术治疗 3例 ( 15 % ) ,鼻胆管胆道引流 1例。 1例胆道损伤因过晚二次手术死亡 ,1例自动出院 ,其余均痊愈出院。结论 胆漏多发生于胆囊切除术及拔除T管后 ,主要原因与局部炎症、迷走胆管存在和操作不当等有关。胆漏发生后治疗方案的选择应该根据腹膜炎的轻重。

Objective To investigate the cause, prevention and treatment of biliary leakage after biliary tract operation.Methods Clinical materials were retrospectively analyzed in 20 patients complicated with Biliary leakage after biliary tract operations were undergone from 1997 to 2002.Results The causes of biliary leakage were: 7cases by injury of liver bed cholangiole or tiny accessory hepatic duct, 6 cases by T-tube removal, 3 cases by surrounding T-tube biliary leakage, 1 case by early T-tube sliding off, 1 case by T-tube carelessly being pulled out, 1 case by biliary injury, 1 case by exfoliation of stump ligature of cystic duct. 16 cases (80%) were treated conservatively and 3 cases (15%) were received second operations. 1 case was treated by drainage of biliary duct. Conclusion Biliary leakage often occurred after cholecystectomy and after the removal of T-tube. It was mainly related with local inflammation, aberrant biliary exist and incorrect manipulation. Conservative therapy was often successful unless frank peritonitis, biliary tract obstruction, or improper peritoneal drainage existed.