Sperlongano P, Pisaniello D, Parmeggiani D, Piatto A, Avenia N, d'Ajello M, Monacelli M, Calzolari F, Lucchini R, Parmeggiani U
Dipartimento di Scienze Anestesiologiche, Chirurgiche e delle Emergenze, V Divisione di Chirurgia Generale e Tecniche Chirurgiche Speciali, Seconda Università degli Studi di Napoli.
G Chir. 2005 Jun-Jul;26(6-7):251-5.
Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries. Anyway, external biliary decompression is a key factor in the treatment, in order to avoid an emergency intervention. The Authors report their experience concerning 3 cases of bile leakages among a series of 458 LC. Only in one of the three cases the subhepatic space was not drained and an emergency laparotomy was performed. The Authors, on the basis of their own experience and of the data reported in literature, suggest the routinary intraoperative placement of a drainage into the subhepatic space, to be removed, if no complications occur, one day after surgery.
腹腔镜胆囊切除术(LC)比开腹胆囊切除术导致胆管损伤的发生率更高。人们对此有所担忧,且LC术后胆汁漏更频繁的原因尚不清楚。胆汁积聚可能由于主要损伤(约75%)或轻微损伤(约25%)引起。无论如何,外部胆道减压是治疗的关键因素,以避免紧急干预。作者报告了他们在458例LC手术系列中3例胆汁漏的经验。仅在三例中的一例中,肝下间隙未进行引流,而是进行了急诊剖腹手术。作者根据自己的经验和文献报道的数据,建议在术中常规在肝下间隙放置引流管,若术后无并发症,术后一天拔除。