腹腔镜胆总管探查术T管拔除后胆漏16例诊治分析OA

Objective To explore the prevention and diagnostic experience of bile leakage after T-tube removal in laparoscopic choledochotomy(LCBDE).Methods A total of 983 cases of LCBDE+T-tube drainage were performed at The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital from August 2017 to March 2024,and the clinical data of 16 patients with bile leakage after T-tube removal were retrospectively analyzed.Results The total incidence of bile leakage following T-tube removal after LCBDE was 1.8%(18 of 983),and the common causes of bile leakage included individual and medical factors.Among the 16 cases,3 cases were treated conservatively by placing drainage tubes to bile drainage through the original sinus tract;4 cases were treated with endoscopic retrograde cholangiopancreatography(ERCP)to remove stones;9 cases were treated with laparoscopic surgery,of which 7 cases were treated with laparoscopic sinus repair,and 2 cases were treated with re-LCBDE+T-tube drainage.The 16 patients cured with no complications(bile leakage,biliary tract infection,or bleeding).And the hospitalization time were(12.3±3.5)days.Conclusion The possible causes of bile leakage after T-tube removal after LCBDE should be fully understood for prevention.Clinically,extraction time can be individualized,T-tube placement and removal standardized,T-tube sinus tract construction technique improved,T-tube reduced and sinus tract integrity evaluated by ultrasound or CT prior to extraction,with delayed extraction if necessary.If bile leakage occurs,non-surgical treatment mainly focusing on the original sinus tract drainage is preferred,and the corresponding surgical treatment is flexibly selected according to the condition if necessary.