Walker A T, Brooks D C, Tumeh S S, Braver J M
Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115.
Semin Ultrasound CT MR. 1993 Oct;14(5):346-55. doi: 10.1016/s0887-2171(05)80054-x.
The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. We have reviewed the first 823 laparoscopic cholecystectomies performed at our institution and found 13 symptomatic biliary complications necessitating further therapy (prevalence 1.6%). This finding represents a decrease from the 2.7% prevalence found in our earlier series. The incidence of biliary complications will likely continue to vary depending on patient selection, operator experience, and new developments in laparoscopic technique. Bile duct injury and bile leaks are often difficult to diagnose but must be strongly considered in postoperative patients with abdominal pain, fever, jaundice, or continued bilious drainage from a surgical drain. Whereas computed tomography (CT) and sonography are sensitive in detecting perihepatic or free peritoneal fluid collections, they are nonspecific and definitive diagnosis of biliary tract injury requires hepatobiliary scintigraphy, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), or percutaneous aspiration. Disruption of the biliary tree has commonly been treated with reoperation or percutaneous drainage. More recently, endoscopic management has shown encouraging results for bile leaks and strictures in small series.
早期报告显示，腹腔镜胆囊切除术后胆道损伤的发生率在0%至7%之间。我们回顾了在我院进行的前823例腹腔镜胆囊切除术，发现13例有症状的胆道并发症需要进一步治疗（发生率为1.6%）。这一发现表明较我们早期系列研究中2.7%的发生率有所下降。胆道并发症的发生率可能会继续因患者选择、术者经验以及腹腔镜技术的新进展而有所不同。胆管损伤和胆漏往往难以诊断，但对于术后出现腹痛、发热、黄疸或手术引流管持续引流出胆汁的患者，必须高度怀疑。虽然计算机断层扫描（CT）和超声检查对检测肝周或游离腹腔积液很敏感，但它们缺乏特异性，胆道损伤的明确诊断需要进行肝胆闪烁显像、内镜逆行胰胆管造影（ERCP）、经皮肝穿刺胆管造影（PTC）或经皮抽吸。胆道树的损伤通常采用再次手术或经皮引流治疗。最近，在内镜治疗小系列胆漏和狭窄方面已显示出令人鼓舞的结果。
