- 期刊
Diagnosis and Treatment of Post-Operative Biliary Leaks
手術後膽汁滲漏的診斷與治療
摘要
膽汁滲漏常發生予腹部手術、外傷、經皮穿肝膽道引流術或肝腫瘤之動脈栓塞後，其中又以腹部手術後最多。膽汁滲漏的治療過去多以外科療法爲主，但是自從膽道內視鏡術發展之後，各種非外科的療法便被引進此一治療領域，本文主旨在探討各種非外科療法（包括經皮導管引流術，內視鏡括約肌切開術，鼻一膽道引流術）對予本病的治療效果。自1994年4月至2000年3月，本院共收集了19位手術後發生膽汁滲漏的病人，其診斷的方法包括超音波、電腦斷層婦描、核醫膽道攝影、經皮抽吸外滲的膽汁及經內視鏡逆行性膽管攝影，而治療的方法已如上述，以非外科的療法爲主，少數病人仍輔以外科治療。滲漏的位置以膽囊管(6)及總膽管(2)為主。另外在左側肝內膽管(1)及右側肝管(2)亦偶而可見，但有3例病人，雖知有膽汁外滲但無法確認滲漏的位置。治療的成效方面，有7例病人在作過經皮導管引流術，解除膽汁性腹膜炎之後，滲漏自動停止。另外，12例病人接受了內視鏡治療，其中包括2例內視鏡括約肌切開術，3例內視鏡鼻膽管引流術，6例則接受前述兩種治療。19例中有18例病人的膽汁滲漏經上述的非外科療法之後，滲漏停止，停止的時間在治療後2到30天之間。失效的l例病人係因爲逆行性膽管攝影失敗，後經外科治療後痊愈。另有2例病人雖膽汁滲漏已停止，但因次發性感染引起腹腔膿瘍，經外科手術引流後痊癒。因此我們的結論是膽汁滲漏的病人經非外科的療法大部份可以痊癒，僅少數病人需外科介入。
並列摘要
Biliary leaks may occur after abdominal surgery, trauma, percutaneous transhepatic cholangiography or transcatheter arterial embolization of hepatic tumor Various non-surgical methods have been used in the treatment of biliary leaks. This study demonstrated the efficacy of percutaneous catheter drainage (PCD) of biloma, endoscopic sphincterotomy(EST), endoscopic nasobiliary drainage (ENBD) and surgery. From April 1994 to March 2000, 19 patients were referred for management of post-operative biliary leaks. Diagnostic studies included sonography, computed tomography (CT scan), cholescintigraphy, aspiration of biloma, and endoscopic cholangiography (ERC). Therapeutic procedures included FCD, ESI ENBD and laparotomy. The leak sites were the cystic duct stump(6), right hepatic duct (2), left intrahepatic duct(1), common bile duct (7), and undefined(3). Eleven patients received FCD and in 7 of them the leak healed without further therapeutic endoscopy or surgery. Five patients among the latter belonged to biliary leaks fellowing T-tube removal. Eleven patients received therapeutic endoscopy(EST in 2, ENBD in 3 and both in 6). For most patients biliary leaks healed within 2 to 30 days after various non-surgical interventions except/br three patients who required laparotomy for abscess drainage (2) or for failed ERC (1). Non-surgical treatments of biliary leaks were effective in most of our patients. Laparotomy for biliary leaks with or without abscess drainage is occasionally required. Most of our patients recovered well except one patient who had biliary stricture as a late complication. Biliary leaks after T-tube removal can usually be treated by FCD alone and therapeutic endoscopy or surgery is not needed.