ERC在腹腔镜胆囊切除术后胆瘘处理中应用.pdfVIP

ERC在腹腔镜胆囊切除术后胆瘘处理中的应用 詹世林陈建雄彭林辉霍枫陆树桐何邹俊 (广州军区广州总医院肝胆外科，广州 510010) 【摘要l目的探讨经内镜逆行胆管造影(ERC)在腹腔镜胆囊切除(LC)术后胆瘘处理中的应用价值。方法：对 16例LC术后胆瘘患者及早应用ERC检查，了解胆瘘的部位、程度、类型。根据具体情况采用鼻胆管引流、腹腔穿刺 置管引流或剖腹探查。结果 胆管引流10-一20天，9例腹腔穿刺置管引流及4例腹腔引流管引流50天，胆瘘愈合。3例肝门部胆管空肠吻合，痊愈 出院。16例随访3个月至3年，中位随访时间1年3个月，无腹痛、发热、黄疸及其他并发症。结论ERCP是LC术 后胆瘘的一种简便、准确、微创的处理方法。 【关键词】经内镜逆行胆管造影；腹腔镜胆囊切除；术后胆瘘；胆管损伤 Thetreatmentof fistulaafter with retrogade biliary iaparoscopiccholecystectomyendoscopic eta1．General Shilin,Chen linhui Jianxiong,Peng HospitalofGuangzhouCommand,PLA．Guangzhou,51001D，Guangdong China． Province, To theeffectof treatment retrogradecholangiography(ERC)inofbiliary 【Abstract】oHecflveinvestigate endoscopic in fistulaafter ERCwasused treatmentof fistulaofsixteen laparoscopiccholecystectomy(LC)．Methods biliary tothe of duct andabdominal forbileinabdominal ERC，nasal—bile cases．Accordingshowing drainage paracentiedrainage showedIA oftrumaof tractin9 or forbileductstenosis．ResultsTheERC cases，IIA cavityexploratorylaparotomy type biliary in9casesfor1 0to20 fistulawere in5cascsandIIID in3cases．Nasal—bileduet wasused type type drainage days．Thebiliary afterabdominal in9casesand4cases withtheLC mbefor5to7 healing paraeenticdrainage drainage drainage days．Three done and a resume．ThereWasno ofabdominal casesofbileductstenosiswere hepaticojejunostomygetgood complication pain in to3 ERCWa