内镜逆行胰胆管造影术在胆囊切除术后胆漏的治疗中的作用

Role of ERCP in the treatment of bile leakage after cholecystectomy

目的 探讨ERCP检查及治疗技术在胆囊切除术后胆漏的治疗过程中的作用。方法 对单纯胆囊切除术后发生的 6 8例胆漏病人诊治过程进行回顾性分析 ,比较有无ERCP检查或治疗时 ,胆漏病例的治疗方案。结果 31例ERCP检查病例中 ,全部明确胆漏性质 ,12例仍需手术处理胆漏。 37例未经ERCP检查病例中 ,2 0例手术治疗处理胆漏 ,其中 5例术前PTC明确胆漏性质 ,其它病例于术中探查判断胆漏部位 ,2例探查误诊误治 ,6例单纯T管外引流术。结论 ERCP检查可明确胆漏的性质 ,提高手术治疗的准确性 ,并为部分病例提供有效治疗 ,降低手术治疗比例。ERCP对胆囊切除术后胆漏治疗具有重要价值。

Objective: To evaluate the role of ERCP in the treatment of bile leakage after cholecystectomy.Methods:sixty-eight cases of bile leakage after cholecystectomy were retrospectively reviewed, and the treatment regimens with or without ERCP were compared.Results: Thirty-one patients received ERCP and the natures of the leakage in all of them were clearly diagnosed. Twelve patients needed surgery for the leakage. Twenty of the 37 patients who did not receive ERCP needed surgery for the leakage. Only 5 patients were clearly diagnosed by PTC before exploration. Two patients were misdiagnosed and resulted in worse conditions. Six patients needed merely T tube drainage. Conclusions: ERCP had a very important role in the treatment of bile leakage after cholecystectomy. It could give a clear diagnosis about the leakage and improve the accuracy of the operation, and could also give a definitive treatment to parts of the patients and reduce the requirement of surgery.