中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (07): 568-571.

• 专题笔谈 • 上一篇    下一篇

医源性胆管损伤所致胆漏的诊治

王    坚,李可为   

  1. 上海交通大学医学院附属仁济医院普外科,上海200127
  • 出版日期:2011-07-01 发布日期:2011-06-17

  • Online:2011-07-01 Published:2011-06-17

摘要:

胆漏是医源性胆管损伤的主要临床表现,也是诊断胆管损伤的重要临床线索。胆漏在Ⅰ型、Ⅱb、Ⅱc型及Ⅲ型胆管损伤中有不同的临床表现,术中诊断率低,术后依靠腹膜炎症状与体征、引流液的性质和影像学资料做出胆漏的定性和定位诊断。胆漏的治疗应强调术中及时发现和正确处理,术后发现胆漏者应遵循损伤控制原则,先行胆道和腹腔引流,再选择恰当的时机进行确定性胆道修复手术。

关键词: 胆管损伤, 胆漏

Abstract:

The diagnosis and treatment of bile leakage caused by iatrogenic bile duct injury        WANG Jian, LI Ke-wei. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medcine, Shanghai 200127, China
Corresponding author: WANG Jian, E-mail: dr_wangjian@yahoo.com.cn

Abstract    Bile leakage is main clinical manifestation and diagnostic clue of iatrogenic bile duct injury. Its symptom and sign varies with the type of injury. Majority is missed intraoperatively and the postoperative diagnosis depends on the manifestation of acute peritonitis, drainage and radiographics. It must be emphasized that it should be found intraoperatively and treated properly. If it is found postoperatively, the damage control principle must be applied. The first step is the drainage of bile duct and peritoneal cavity, then the appropriate operation timing is chosen for definitive operation.

Key words: bile duct injury, bile leakage