目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后迟发性胆漏的发生原因、诊治方法及预防措施.方法:回顾分析5例LC术后迟发性胆漏患者的临床资料.结果:5例患者胆漏发生时间为术后5～10 d,平均(7.4±1.7)d；其中迷走胆管损伤、焦痂脱落2,胆囊管钛夹滑脱1例,胆总管电灼伤1例,原因不明1例.1例于B超引导下穿刺引流治愈；3例行腹腔镜探查术,其中1例行迷走胆管结扎、腹腔引流术,2例分别行开腹迷走胆管缝扎及胆囊管缝扎、腹腔引流术；1例胆总管损伤患者经内镜逆行胰胆管造影/内镜鼻胆管引流术+B超引导腹腔穿刺引流术治愈.住院12 ～ 21 d,平均(15.3±2.1)d；出院后1年复查,无胆道狭窄、胆系感染等并发症发生,生活质量良好.结论:LC术后迟发性胆漏的发生原因主要有迷走胆管损伤、胆管电灼损伤及胆囊管处理不当.内镜及介入治疗具有较好的应用前景.%Objective:To investigate the reasons,diagnosis,treatment and prevention of delayed bile leakage after laparoscopic cholecystectomy (IX). Methods:The clinical data of 5 cases of delayed bile leakage after LC were retrospectively analyzed. Results; Delayed bile leakage occurred in 5-10 days after LC,the mean was (7. 4 ±1.7) d. The causes of the complication included aberrant bile duct injury and eschar abscission (2 cases) ,loosed titanium clip (1 case) ,and electronic injury of common bile duct (1 case). Additionally ,the cause of one case was unknown, which was cured by B-ultrasound guided drainage. Three cases underwent laparoscopic exploration. Among them,one case was treated by aberrant bile duct ligation and abdominal drainage;two cases were converted to lapa-rotomy and underwent aberrant bile duct suture and cystic duct suture, combined with abdominal drainage. All the three cases were cured. Moreover, one case was cured by endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage and ultrasound guided drainage. The mean duration of hospitalization was (15.3±2.1) d (12-21 d).No stricture of the bile duct and biliary tract infection were found after 1-3 years' following up,quality of life was good. Conclusions:The causes of delayed bile duct leakage after LC include aberrant bile duct injury,electronic injury of the bile duct and mishandling the cystic duct. Endoscopic and interventional treatments have a promising future in the treatment of the delayed bile leakage.
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