Morgenstern L, Berci G, Pasternak E H
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Surg Endosc. 1993 Sep-Oct;7(5):432-8. doi: 10.1007/BF00311738.
The incidence of bile leaks has increased with laparoscopic cholecystectomy as compared with open cholecystectomy. Minor bile leaks are not infrequent but are clinically insignificant; of the major bile leaks the most common sequela is the biloma, the most serious, bile peritonitis. Early symptoms may be very subtle; all untoward symptoms should be investigated with a HIDA scan to rule out bile leakage. Positive HIDA scans should be followed with endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC). Management of the leakage depends on identification of its source. Prompt identification of ductal injuries permits earlier effective treatment and consequently less morbidity and/or mortality.
与开腹胆囊切除术相比，腹腔镜胆囊切除术后胆漏的发生率有所增加。轻微胆漏并不罕见，但临床上无明显意义；在严重胆漏中，最常见的后遗症是胆汁瘤，最严重的是胆汁性腹膜炎。早期症状可能非常隐匿；所有异常症状都应通过肝胆动态显像（HIDA）扫描进行检查，以排除胆漏。HIDA扫描呈阳性时，应接着进行内镜逆行胆管造影（ERC）或经皮经肝胆管造影（PTC）。漏液的处理取决于其来源的确定。及时识别胆管损伤可实现更早的有效治疗，从而降低发病率和/或死亡率。
