Kim Kook Hyun, Kim Tae Nyeun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Clin Endosc. 2014 May;47(3):248-53. doi: 10.5946/ce.2014.47.3.248. Epub 2014 May 31.
BACKGROUND/AIMS: Bile leakage is an uncommon but serious complication of cholecystectomy. The aim of this study is to evaluate the efficacy of the endoscopic management of bile leakage after cholecystectomy.
A total of 32 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), because of bile leakage after cholecystectomy, from January 2000 to December 2012 were reviewed retrospectively. The clinical parameters, types of management, and procedure-related complications were documented.
Most bile leakages presented as percutaneous bile drainage through a Hemovac (68.8%), followed by abdominal pain (18.8%). The sites of bile leaks were the cystic duct stump in 25 patients, intrahepatic ducts in four, liver beds in two, and the common bile duct in one. Biliary stenting with or without sphincterotomy was performed in 22 and eight patients, respectively. Of the four cases of bile leak combined with bile duct stricture, one patient had severe bile duct obstruction and the others had mild stricture. Concerning endoscopic modalities, endoscopic therapy for bile leak was successful in 30 patients (93.8%). Two patients developed transient post-ERCP pancreatitis, which was mild, and both recovered without clinical sequelae.
The endoscopic approach of ERCP should be considered a primary modality for the diagnosis and treatment of bile leakage after cholecystectomy.
背景/目的：胆漏是胆囊切除术后一种不常见但严重的并发症。本研究的目的是评估内镜治疗胆囊切除术后胆漏的疗效。
回顾性分析2000年1月至2012年12月期间因胆囊切除术后胆漏而接受内镜逆行胰胆管造影（ERCP）的32例患者。记录临床参数、治疗类型和与手术相关的并发症。
大多数胆漏表现为经Hemovac进行经皮胆汁引流（68.8%），其次是腹痛（18.8%）。胆漏部位在25例患者中为胆囊管残端，4例为肝内胆管，2例为肝床，1例为胆总管。分别有22例和8例患者进行了带或不带括约肌切开术的胆管支架置入术。在4例胆漏合并胆管狭窄的病例中，1例患者有严重胆管梗阻，其他患者有轻度狭窄。关于内镜治疗方式，30例患者（93.8%）的胆漏内镜治疗成功。2例患者发生轻度的ERCP术后短暂性胰腺炎，均康复且无临床后遗症。
ERCP内镜治疗方法应被视为胆囊切除术后胆漏诊断和治疗的主要方式。
