腹腔镜胆囊切除术后胆漏及胆管损伤17例的临床分析.doc

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1、腹腔镜胆囊切除术后胆漏及胆管损伤17例的临床分析【摘要】目的分析腹腔镜胆囊切除术后胆漏及胆管损伤的原因、治疗方法及预后。方法总结2000年1月～2004年12月17例腹腔镜术后胆漏及胆管损伤的患者，行回顾性分析。结果17例患者中3例迷走胆管漏经剖腹缝扎胆囊床，腹腔引流后治愈;胆囊管残端漏3例，3例均再次手术结扎治愈;胆总管损伤漏6例，肝总管损伤漏2例，右肝管损伤漏1例，剖腹手术修补漏口，放置T型管支撑4～6个月;胆总管横断2例剖腹行胆总管端端吻合放置T管支撑6个月。术后随访1～3年，15例恢复良好，2例反复出现胆管

2、炎，经行胆管空肠Roux-en-Y吻合治愈。结论腹腔镜胆囊切除术后的胆漏及胆管损伤，应及时发现，正确处理。　　关键词腹腔镜胆囊切除术胆漏胆管损伤　　Analysisof17casesofbileleakageandbileductinjuryinlaparoscopiccholecystectomy　　【Abstract】ObjectiveToanalyzethecauseofbileleakageandbileductinjuryoflaparoscopiccholecystecto-my，andtodiscus

3、sitstreatmentmethodsandprognosis.Methods17casesofbileleakageandbileductinjuryofla-paroscopycholecystectomybetweenJan.2000andDec.2004retrospectivelyanalyzed.ResultsIn17cases，themini-bileductleakagewere3.Allthosegroupwerecuredbysewingupthegallbiadder-bedandthebe

4、llycavitydrainaged.Thecysticductleakagewere2cases，those3caseswereseweduptheleakofthecysticductandthebellycavitydrainaged.Thecholedochleakagewere6cases，inwhich6casesweresewedupthecholedochleakageandplacedTtypetubetodrainagebilefor4～6months.Thecommonhepaticductl

5、eakagewere3cases，inwhich2caseswereseweduptheleakageofcommonhepaticductandplacedTtypetubetodrainagebilefor4～6months.Therighthepaticductleakagewas1cases，inwhich1caseswasseweduptheleakageofrighthepaticductandplacedTtypetubetodrainagebilefor6months.Thecommebileduc

6、twerecut2cases，inwhich2caseswereoperatedbileductandbileductanastomosis，placedTtypetubetodrainagebilefor6months.Allcaseswerefollowed-upfor1～3years.15casesweregoodcurativeeffectafterthesecondoperation，2casesappearedcholangitisagainandagainafterthesecondoperation

7、，inwhichoneweoperatedbybileductjejunumRoux-en-Yanastomosisagain，inwhichotheroneweop-eratedbyrighthepaticduct-jejunumRoux-en-Yanastomosisagain.ConclusionThebileleakageandthebileductinjuryoflaparoscopiccholecystectomyshouldbediscoveredontime，treatedexactitudy.4　

8、　Keywordslaparoscopecholecystectomybileleakagebileductinjury　　随着现代光电技术的飞速发展及腹腔镜外科技术的推广，腹腔镜胆囊切除术（laparoscopiccholecystectomy，LC）已成为治疗胆囊良性疾病的首选方法，具有损伤小、痛苦少、恢复快、住院时间短、患者易接受等优点。腹腔镜手术有其