术后胆漏原因及防治分析

Causes and Treatment of Postoperative Bile Leakage

目的 探讨胆漏的原因及防治策略。方法 回顾分析 1993年 2月— 2 0 0 3年 8月 45例术后发生胆漏原因、治疗方法及效果。结果 3 1例采用非手术治疗 ,3例死亡 ,非手术治疗治愈率 90 3 % ,死亡率 9 7%。 14例首选手术治疗 ,4例死亡 ,死亡率 2 8 6%。全组总治愈率84 4% ( 3 8/4 5 ) ,死亡率 15 6% ( 7/4 5 )。结论 胆漏多发生于胆囊切除 (LC及OC)及胆总管探查T管引流术后 ,尤多见于急诊胆道手术 ,其原因主要与炎症、粘连、解剖变异和操作不仔细有关 ,预防应从首次手术前、中、后三个环节着手。胆漏发生后应根据胆漏的部位、量及有无合并肠液胰液、腹膜炎范围、腹腔有无脓肿形成等选择手术治疗或非手术治疗。

Objective To investigate the cause,prevention and treatment of bile leakage. Methods The clinical data of 45 cases with postoperative bile leaktage treated from Feb 1993 to Aug 2003 were reviewed retrospectively. Results Of the 31 cases treated with nonoperative therapy 3 patients died the cure rate of nonoperation was 90.3%(28/31),mortality was 9.7%(3/31). 14 patients were cored with emergent operation at the beginning of bile leakage,4 patients died mortality was 28.6%(4/l4).The totaI cure rate was 84.4%(38/45),mortality was 15.6%(7/45).Conclusion Bile leakage of occurs in cholecystectomy procedure (LC or OC) and exploration and T-tube draniage of common bile duct especially with the emergency cases,which is mainly related to inflammation,adhesion,abnormality of anatomy and incorrect manipulation. In order to prevent it,surgeons should pay more attention to the 3 links of primary procedure,including preoperative preparation,operative mangement and postoperative treatment. Different treatments are optional according to the site,degree and content of the leakage. The patients condition such as degrec of peritonitis,abdominal abscess or not and general condition of physical should beconsided.