Rayter Z, Tonge C, Bennett C E, Robinson P S, Thomas M H
Department of Surgery, St. Peter's Hospital, Chertsey, Surrey, UK.
Br J Surg. 1989 Oct;76(10):1046-8. doi: 10.1002/bjs.1800761021.
Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethylphenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.
胆囊切除术后放置引流管通常用于避免胆漏及随后的腹膜炎。35例未放置引流管而行胆囊切除术的患者于术后次日上午接受了99mTc标记的二甲基苯甲酰甲基亚氨基二乙酸（HIDA）扫描及超声检查。HIDA扫描阳性检测出11例胆漏。20次超声检查发现肝下有液体积聚。胆漏与肝下积液之间无关联。许多积液在HIDA扫描中未被发现，提示积液中含有的是血液而非胆汁。许多发生胆漏的患者未出现液体积聚。临床并发症较少，且在扫描阳性和阴性的患者中分布均匀。我们得出结论，胆漏并非偶发事件，而是在31%未放置引流管的胆囊切除术后发生，且这些胆漏在临床上并不重要。
