Barband Ali Reza, Kakaei Farzad, Daryani Amir, Fakhree M Bassir A
Department of General Surgery, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Surg Laparosc Endosc Percutan Tech. 2011 Aug;21(4):288-91. doi: 10.1097/SLE.0b013e31822a2373.
Bile leakage is one of the most important complications of laparoscopic cholecystectomy, and it has been recognized as a major clinical challenge during the last 2 decades. Although endoscopic and percutaneous interventions are widely accepted in the management of bile leakage, relaparoscopy permits the bile drainage adequately and gives direct control of bile leakage site in selected patients.
Data for patients with minor bile leakage after laparoscopic cholecystectomy were collected from January 2001 to January 2010. Patients were categorized in 2 groups, nonoperative and relaparoscopy. Clinical presentation, kind of management, and outcomes were evaluated in 2 groups.
After a total of 2652 laparoscopic cholecystectomies, postoperative minor bile leakage occurred in 17 (0.64%) patients. Four patients with minimal leakage were managed by percutaneous drainage alone. Endoscopic retrograde cholangiopancreatography was applied to 4 patients with jaundice, high output bile fistula, and a patient with retained common bile duct stone. Bile leakage was controlled in 3 of the 4 patients. There were 9 patients in the relaparoscopic group to which 1 patient was added after unsuccessful endoscopic intervention. The source of bile leakage in the relaparoscopic cases was defined as 50% from cystic duct stump and 50% from Luschka or accessory ducts. The success rate of bile leakage control after relaparoscopy was 90%. The mean of hospital stay after relaparoscopy was 3 days (range, 2-10 d) and after endoscopic retrograde cholangiopancreatography intervention or percutaneous drainage was 10 days (range, 3-28 d).
Relaparoscopy is an effective procedure in the management of minor bile leakage after laparoscopic cholecystectomy and can be an alternative approach in selected situations.
胆漏是腹腔镜胆囊切除术最重要的并发症之一，在过去20年里一直被视为一项重大临床挑战。尽管内镜和经皮介入在胆漏处理中被广泛接受，但再次腹腔镜手术能充分引流胆汁，并可直接控制特定患者的胆漏部位。
收集2001年1月至2010年1月期间腹腔镜胆囊切除术后发生轻微胆漏患者的数据。患者分为两组，非手术组和再次腹腔镜手术组。对两组患者的临床表现、处理方式及结果进行评估。
在总共2652例腹腔镜胆囊切除术后，17例（0.64%）患者发生术后轻微胆漏。4例渗漏极少的患者仅通过经皮引流处理。4例出现黄疸、高流量胆瘘的患者以及1例存在胆总管结石残留的患者接受了内镜逆行胰胆管造影术。4例患者中有3例胆漏得到控制。再次腹腔镜手术组有9例患者，其中1例在内镜干预失败后加入该组。再次腹腔镜手术病例中胆漏的来源确定为50%来自胆囊管残端，50%来自卢氏管或副胆管。再次腹腔镜手术后胆漏控制的成功率为90%。再次腹腔镜手术后的平均住院时间为3天（范围2 - 10天），内镜逆行胰胆管造影术干预或经皮引流后的平均住院时间为10天（范围3 - 28天）。
再次腹腔镜手术是处理腹腔镜胆囊切除术后轻微胆漏的有效方法，在特定情况下可作为一种替代方法。
