肝胆手术后并发胆漏诊断及治疗.docVIP

肝胆手术后并发胆漏诊断及治疗 　【关键词】 肝胆 摘要：目的：探讨肝胆手术后胆漏的防治措施。方法：回顾性分析近十年来我院诊治的11例胆漏患者的临床资料。结果：6例患者经常规的通畅引流、营养支持及预防感染等治疗，2～3周治愈；2例患者在B超声波引导下穿刺置管引流，3周后治愈；2例患者行2次手术引流后4周治愈，1例带管出院。上述患者住院期间均未出现新的并发症。结论：正确的手术方法，熟练的手术操作，充分的引流是预防损伤性胆漏的关键；术后认真、严密的观察，早发现、早诊断及选择正确的处理方法是治疗术后胆漏，避免造成严重后果的重要保证。 关键词：肝胆手术；胆漏；诊断；治疗 Diagnosis and Treatment of Bile Leakage After Hepatobiliary Surgery Abstract：Objective：To investigate prevention, diagnosis and treatment of postoperative biliary leakage caused by hepatobiliary surgery. Method: The clinical datum of 11 patients with bile leakage after hepatobiliary surgery have been analyzed retrospectively in our hospital for recent 10 years. Result: 6 patients treated with conventional draining, nutritional supportting and prevention infection were cured after 2～3 weeks; 2 patients were cured with ultrasionic-guided puncture and drainage after 3 weeks treatment; another 2 patients were cured with operative drainage after 4 weeks; 1 patient discharged with catheter. All patients didn’t appeared new complications during hospital stay. Conclusion: Correct operation, perfect operative procedure and sufficient draining were important juncture to prevent bile leakage, the earnest and rigorous observation of postoperation, early detection , early diagnosis and correct measurement were guarantee to advoid severe consequences. Key words：Hepatobiliary surgery；Bile leakage；Diagnosis；Treatment 胆漏是肝胆外科手术发生率相对较高的一种并发症，处理不当将增加患者的痛苦，甚至可能危及患者的生命［1］，如何防止胆漏的发生及正确处理胆漏，是临床上值得探讨的问题。本文结合我院近十年来诊治的11例胆漏患者的情况进行回顾性分析总结，报道如下。 1临床资料 1.1一般资料：本组11例患者，男4例，女7例，年龄26～72岁，平均年龄48.3岁，均发生在肝胆手术后，其中结石性胆囊切除术胆漏5例（胆囊结石伴化脓性胆囊炎4例，慢性结石性胆囊炎1例）；胆总管放置T管早期胆漏3例（肝内、外胆管结石行胆总管切开取石T管引流2例，胆管癌行附加肝叶切除根治术T管引流1例）；拔T管后胆漏2例（均为胆总管切开探查T管引流）；胆肠吻合术后吻合口漏1例。 1.2临床表现：肝胆手术后患者出现局限性、弥漫性腹膜炎表现，或从腹腔引流管、伤口引流出过多的异常的胆汁。诊断主要依据手术史、临床表现、腹腔穿刺及各种影像学检查等。本组胆漏发现的时间：术后3d之内7例，术后4～7d 3例，拔除T管后1例。 1.3治疗措施：传统的治疗方法是保持腹腔引流和胆管引流通畅，营养支持、防治感染及并发症，再手术治疗［2］。在传统治疗方法的基础上，根据患者的病情特点，我们采用单纯行腹腔引流9例，即发现胆漏后如原有腹腔引流，则继续保持引流管通畅，同时给予禁食、肠外营养、应用有效抗菌素、严密观察腹部体征等非手术治疗；如原没有