Clinical analysis of bile leakage during laparoscopic cholecystectomy
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摘要: 目的 腹腔镜胆囊切除术(laparoscopic chelocystectomy,LC)在中国等发展中国家需要大量的培训和经验。对LC术后的并发症进行探讨,是建立手术的有效性和安全性的关键。LC可出现胆漏等并发症。本研究旨在分析探讨胆漏的发生原因、对其预防及治疗的基础上,进一步降低胆漏的发生率。 方法 收集蚌埠医学院第二附属医院普外科从2006年1月—2015年7月期间774例LC术后患者资料,回顾性分析性其中发生胆漏患者的临床参数、处理方式和手术相关并发症。 结果 774例LC术后,3例患者在术后出现发热、寒战、黄疸、腹痛等症状,经B超下腹腔穿刺出胆汁,确诊为胆漏,发病率为0.39%,其中胆囊床毛细胆管漏1例,胆囊管钛夹滑脱1例,迷走胆管漏1例。根据不同的原因,采取相应的措施,胆囊床毛细胆管漏1例采用B超引导下行腹腔穿刺置管引流术;胆囊管钛夹滑脱1例及迷走胆管漏1例在腔镜下行残端结扎术。3例患者均治愈出院,随访无远期并发症。 结论 胆漏是LC后常见且严重的并发症,手术者应该对患者和手术难度进行认真而又仔细的评估,充分认识手术存在的风险,积极预防和避免术后并发症的发生。胆漏常见于术中胆管损伤和胆囊管结扎脱落,因此术中对胆囊管的准确辨认,发现后应及时的腹腔引流和手术治疗是应对胆漏的关键。Abstract: Objective Bile leakage is the common complication of Laparoscopic cholecystectomy.The purpose of this study was to investigate the causes,treatment and prevention of bile leakage during LC. Methods The clinical data of 774 patients with LC in our hospital between January,2006 and July,2015 was retrospectively analyzed.The clinical parameters,types of management and procedure-related complications were documented. Results Three cases of bile leakage were observed in 774 cases undergoing LC.3 patients presented postoperative fever,chills,jaundice,and abdominal pain and so on.The abdominal cavity puncture under ultrasound diagnosed as bile leakage,the incidence rate was 0.39%.Of 3 cases of bile leakage,one case of capillary bile leakage in gallbladder bed was treated with abdominal drainage guided ultrasound,one case of cystic duct titanium clip slip off and other one was aberrant duct were treated with laparoscopic stump ligation,all three were cured and discharged.The follow up showed there were no long-term complications. Conclusion Bile leakage is a common and serious complication after LC.The operator should carefully evaluate the assessment of the patients and the surgical difficulty,fully understand the risk of surgery,and actively prevent and avoid the occurrence of postoperative complications.Bile leakage is mainly due to bile duct injury and bile duct ligation of the cystic duct off.Accurate identification of the cystic duct during the operation,the timely abdominal drainage and surgical treatment are critical for prevention of the bile leakage caused by LC.
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Key words:
- Laparoscopic /
- Cholecystectomy /
- Bile Leakage /
- Prevention
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