胆道手术后胆漏临床分析.docVIP

胆道手术后胆漏临床分析 　　摘 要：目的 研究胆道手术后出现胆瘘的原因及相应预防措施。方法 选取我院2006年1月～2017年1月胆道手术治疗后出现胆瘘的56例患者，对其进行分析、寻找原因、观察治疗效果。结果 17例患者由于胆囊床的毛细胆管和细小副肝管损伤出现胆漏，12例由于胆囊残端漏导致，9例由于?总管损伤导致，6例术后早期T管脱落引起胆漏，5例由于术后T型管拔除后出现胆漏，4例由于肝创面胆漏，3例由于胆肠吻合口漏。手术治疗后，52例（92.86%）患者痊愈，4例（7.14%）实施十二指肠术后出现胆漏合并中毒和多脏器功能衰竭现象。结论 胆道手术前医护人员应全面掌握肝胆的详细解剖结构，具备熟练的操作技巧，这样才能够有效降低术后出现胆瘘的几率。 　　关键词：胆道手术；胆瘘；预防措施 　　中图分类号：R657.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.076 　　文章编号：1006-1959（2018）01-0189-02 　　Clinical Analysis of Bile Leakage after Biliary Surgery 　　ZHANG Zhen-gang 　　（Department of General Surgery，Peoples Hospital of Xifeng District，Qingyang 745000，Gansu，China） 　　Abstract：Objective To study the causes of gallbladder fistula after biliary tract surgery and corresponding preventive measures.Methods 56 patients with biliary fistula after biliary surgery in our hospital from January 2006 to January 2017 were analyzed，the reasons were investigated，and the therapeutic effect was observed.Results In 17 patients，gallbladder leakage occurred in the gallbladder bed and small accessory hepatic duct.12 cases with gallbladder stump leakage in 9 cases，the common bile duct injury，6 cases of early postoperative T tube shedding induced by bile leakage，5 cases due to removal of the T tube after postoperative bile leakage，4 cases of liver wound due to bile leakage，3 cases with biliary enteric anastomotic leakage.After surgical treatment.52 cases（92.86%）were cured，4 cases（7.14%）the implementation of postoperative duodenal bile leakage and poisoning complicated with multiple organ failure.Conclusion Biliary tract surgery before medical personnel should fully grasp the detailed anatomy of the liver， with the operation of skilled，so that it can effectively reduce the risk of biliary fistula occurred after operation.近年来，我国临床手术治疗胆道疾病的患者日渐增多，手术治疗能改善患者的临床症状，提高患者生存质量[1]。胆道手术后胆漏是指含有胆汁的液体通过非正常渠道持续流出，若是未采取积极有效的治疗措施，会使患者出现如发热、腹痛、恶心等一系列症状，情况严重者甚至会出现中毒性休克[2]。本研究选择我院2016年1月～2017年1月胆道外科实施手术治疗后出现胆瘘的56例患者，分析患者的临床资料，以期为临床中预防手术治疗后胆瘘的发生提供参考。 　　1资料与方