胆道手术后胆漏18例诊治体会

Treatment experience of 18 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 18例患者的临床资料进行回顾性研究。结果 18例发生胆漏原因为肝床胆管或细小副肝管损伤 7例、胆道损伤 1例、T管早期滑脱及T管不慎拽出各 1例、胆囊管残端结扎线脱落 1例、拔T管后胆漏 4例、T管周围胆漏 3例。本组保守治疗 13例 ( 72 .2 %) ,再手术治疗 4例 ( 2 2 .2 %) ,鼻胆管胆道引流 1例。 1例胆道损伤因再次手术后出现多器官系统功能衰竭而死亡 ,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 ,肝外胆管的解剖变异和病理改变、术者经验不足、操作不仔细、手术方式选择不当是造成胆漏的常见原因。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 leakge after biliary tract operation.Methods Clinicl materials were retrospectively analyzed in 18 patients complicated with biliary leakag after biliary tract opertions were undergone from 1997 to 2002.Results The causes of biliary leakage were:7 cases by injury of liver bed cholangiole or tiny accessory hepatic duct,1 case by biliary injury,1 case by early T-tube sliding off,1 case by T-tube carelessly being pulled out,1 case by exfoliation of stunp ligature of cystic duct,4 cases by T-tube removal,3 cases by surrounding T-tube biliary leakage.13 cases(72.2%) were treated conservatively and 4 cases(22.2%) were received second operations. 1 case was treated by drainage of biliary dust.Conclusions Biliary leakage often occurred after cholecystectomy and after the removl of T-tube, The causes of bile leakage are reated to the dissection aberrance and pathollogy change of outer-liver bile dust,operater's experience,incorrect manipulation. Conservative therapy was often success unless frank peritionits,biliary tract obstruction,or improper pertioneal drainage existed.