Sugiyama M, Mori T, Atomi Y
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 1999 Mar-Apr;46(26):762-5.
BACKGROUND/AIMS: Bile leaks are common complications of laparoscopic cholecystectomy. We evaluated the diagnosis and endoscopic treatment of bile leaks.
A total of 436 patients underwent laparoscopic cholecystectomy with infrahepatic drainage. We performed immediate endoscopic retrograde cholangiopancreatography (ERCP) on all patients with bile discharge from an infrahepatic drain, and treated bile leaks which were not due to a major ductal injury by endoscopic nasobiliary drainage (ENBD) without endoscopic sphincterotomy (ES).
Ten patients developed bile leaks which were recognized within 18 hours of operation. ERCP, on post-operative day 1 or 2, showed a bile leak from the cystic duct (9 patients) or the liver bed (1 patient). All patients underwent ENBD. Only 1 patient, who had a retained stone, had ES. In all patients, the bile leak resolved promptly and both the infrahepatic and nasobiliary drains were removed within 6 days of cholecystectomy. All patients were asymptomatic at a mean follow-up of 30 months.
Routine placement of an infrahepatic drain is recommended for the early detection of bile leaks. Bile leaks can be successfully treated by prompt ENBD without ES.
背景/目的：胆漏是腹腔镜胆囊切除术常见的并发症。我们评估了胆漏的诊断及内镜治疗。
共有436例患者接受了腹腔镜胆囊切除术并放置肝下引流管。对于所有从肝下引流管有胆汁引出的患者，我们均立即行内镜逆行胰胆管造影（ERCP），对于非主要胆管损伤所致的胆漏，采用内镜鼻胆管引流（ENBD）治疗，不行内镜括约肌切开术（ES）。
10例患者发生胆漏，均在术后18小时内被发现。术后第1天或第2天行ERCP检查显示，9例患者胆漏来自胆囊管，1例来自肝床。所有患者均接受ENBD治疗。仅1例有残留结石的患者行ES。所有患者胆漏均迅速缓解，胆囊切除术后6天内肝下引流管和鼻胆管引流管均拔除。平均随访30个月时，所有患者均无症状。
建议常规放置肝下引流管以早期发现胆漏。通过及时行ENBD且不行ES可成功治疗胆漏。
