Brady A P, McGrath F P, Moote D J, Malone D E
Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Clin Radiol. 1992 Nov;46(5):333-6. doi: 10.1016/s0009-9260(05)80379-4.
The incidence of biloma formation after laparoscopic cholecystectomy (LC) is, in the early experience of many centres, significantly higher than after open cholecystectomy. We describe four cases representative of the possible spectrum of post-LC bile leaks and review the literature regarding the radiologic investigation and management of this complication. We suggest that post-LC bilomas should initially be drained percutaneously. Endoscopic cholangiography (ERC) should then be used to identify the source of the leak, but sphincterotomy and/or stent placement may be best reserved for those whose leaks do not resolve after 10 days of free drainage. Surgery is recommended only for major biliary injury and for leaks that remain unresolved after sphincterotomy and/or stenting. An algorithmic summary of this approach is presented.
在许多中心的早期经验中，腹腔镜胆囊切除术（LC）后胆漏的发生率显著高于开腹胆囊切除术。我们描述了4例代表LC术后可能出现的胆汁漏情况的病例，并回顾了关于该并发症的放射学检查及处理的文献。我们建议，LC术后胆漏最初应采用经皮引流。然后应使用内镜胆管造影（ERC）来确定漏出源，但括约肌切开术和/或支架置入术最好仅用于那些在自由引流10天后漏出仍未解决的患者。仅在出现严重胆管损伤以及括约肌切开术和/或置入支架后漏出仍未解决时才建议进行手术。本文给出了该方法的算法总结。
