摘要
目的 探讨腹腔镜胆囊切除术 (LC)后胆囊管瘘的诊断和处理方法。方法 回顾性分析 3例LC术后胆囊管瘘病例的临床资料。结果 3例均为女性 ,因慢性结石性胆囊炎行LC。临床表现分别为原有心律失常的加重 ,腹腔引流管引流出胆汁 ,以及脐部穿刺孔溢出胆汁样液。确定诊断的时间分别是术后第 1天、第 2天和第 2 0天。 2例再次行腹腔镜手术 ,套扎关闭开放的胆囊管 ,腹腔冲洗并引流 ;1例行腹腔穿刺置管引流 ,并经内镜乳头切开及置入胆道支架。 3例均获治愈。结论 LC术后胆囊管瘘临床表现多样 ,B超可以发现腹腔积液 ,确定诊断依赖于MRCP和ERCP。微创手术可以安全有效地处理这一并发症。腹腔镜再手术可以有效地关闭开放的胆囊管 ;
Objective To evaluate the methods used in the diagnosis and management of cystic duct fistula after laparoscopic cholecystectomy (LC). Methods Retrospective study of the clinical materials of 3 cases of cystic duct fistula after LC was made. Results Three patients were all female and underwent LC for chronic cholecystitis with stones. Their clinical symptoms were worsening of pre-existed cardiac arrhythmia, bile drained out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made on the 1st, 2nd and 20th post-operative day. Two patients were managed under laparoscopy. The opened cystic duct stumps were closed with endo-loop, with the abdomen irrigated and drained. One was drained with percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. Conclusions The clinical manifestations of cystic duct fistula were different. Ascites can be found under B ultrasound. Final diagnosis relies on MRCP and/or ERCP. Minimally invasive techniques can be applied to this complication safely and effectively. Re-operation for closure of the opened cystic duct stump can be fulfilled under laparoscopy. Endoscopic drainage must be accompanied by effective abdominal drainage.
出处
《消化外科》
CSCD
2004年第3期171-174,共4页
Journal of Digestive Surgery
关键词
胆囊管瘘
胆囊切除术
腹腔镜
诊断
治疗
cystic duct fistula cholecystectomy laparoscope diagnosis treatment
