Katsinelos Panagiotis, Kountouras Jannis, Paroutoglou George, Beltsis Athanasios, Zavos Christos, Chatzimavroudis Grigoris, Vasiliadis Ioannis, Papaziogas Basilis
Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki, Greece.
Hepatogastroenterology. 2006 Mar-Apr;53(68):166-70.
BACKGROUND/AIMS: Bile leak is among the most common and serious complications of biliary tract surgery. The aim of this non-randomized study was to evaluate the role of endoscopic intervention as an accepted treatment for this complication.
An endoscopic retrograde cholangiopancreatography (ERCP) database was reviewed retrospectively to identify all cases of bile leak related to cholecystectomy (laparoscopic or open). Patients' records and endoscopy reports were reviewed. Moreover, structured telephone interviews were conducted to collect data.
Twenty-four patients, 4 males and 20 females, with a median age of 54 (range 28-76 years) with suspected postcholecystectomy bile leaks were referred for ERCP performed 3-73 days after operation (mean 9.5 days). All but one case had high-grade bile-like liquid outflowing from the original drainage tubes or the fistulous tract of T-tube. One patient presented with bilious ascites, 17 patients had sudden or gradual abdominal pain, 3 jaundice, 2 abdominal pain with fever, and 1 nausea and vomiting. ERCP was successful in all cases, and revealed leakage from the cystic stump in 10 cases, from a common bile duct (CBD) defect in 6, from a common hepatic duct defect in 3, from the gallbladder bed in 2, from a T-tube track in 1, and complete CBD transection in 2 patients. Seventeen patients were successfully treated by endoscopic sphincterotomy (ES) plus endoprosthesis, 3 by stent placement without sphincterotomy, 2 with complete transection by proximal hepaticojejunostomy, and 2 patients with leakage from the cystic stump and a CBD defect were operated after unsuccessful endoscopic intervention.
ERCP is recommended as a safe and efficacious intervention to detect and treat postoperative bile leaks. ES plus endoprosthesis is effective for the treatment of bile leakage. Endoscopic stenting without sphincterotomy may be offered as a primary option in young patients with postoperative bile leaks.
背景/目的：胆漏是胆道手术最常见且最严重的并发症之一。本非随机研究的目的是评估内镜干预作为该并发症公认治疗方法的作用。
回顾性分析内镜逆行胰胆管造影（ERCP）数据库，以确定所有与胆囊切除术（腹腔镜或开放手术）相关的胆漏病例。查阅患者记录和内镜检查报告。此外，通过结构化电话访谈收集数据。
24例患者，4例男性和20例女性，中位年龄54岁（范围28 - 76岁），疑似胆囊切除术后胆漏，于术后3 - 73天（平均9.5天）接受ERCP检查。除1例患者外，所有患者均有从原引流管或T管瘘道流出的大量胆汁样液体。1例患者出现胆汁性腹水，17例患者有突发或渐进性腹痛，3例黄疸，2例腹痛伴发热，1例恶心呕吐。所有病例ERCP均成功，发现10例患者胆囊残端漏，6例胆总管（CBD）缺损漏，3例肝总管缺损漏，2例胆囊床漏，1例T管通道漏，2例患者胆总管完全横断。17例患者通过内镜括约肌切开术（ES）加内置支架成功治疗，3例仅放置支架未行括约肌切开术，2例胆总管完全横断患者行近端肝空肠吻合术，2例胆囊残端和CBD缺损漏患者在内镜干预失败后接受手术治疗。
推荐ERCP作为检测和治疗术后胆漏的安全有效干预措施。ES加内置支架对胆漏治疗有效。对于术后胆漏的年轻患者，可不进行括约肌切开术直接行内镜支架置入作为首选方案。
