腹腔镜胆囊切除术后胆漏原因及防治-外科学(肝胆外科)专业论文.docxVIP

重庆医科 重庆医科大学硕士研究生学位论文 万方数据 万方数据 英汉缩略语名词对照 英文缩写 LC 英文全称 Laparoscopic Cholecystectomy 中文译名 腹腔镜下胆囊切除术 Calot’s triangle 胆囊三角 MRCP ERCP Magnetic Resonance Cholangiop Endoscopic Retrograde Cholangi ancreatography 磁共振胰胆管成像 opancreatography 内镜下逆行胰胆管造 影 EST Endoscopic sphincterotomy 内镜下十二指肠乳头 括约肌切开术 CVS LUS IOC BDI the Critical View of Safety Laparoscopic Ultrasound Introperayive Cholangiography Bile Duct Injury Learning Curve 安全的关键观点 腹腔镜超声 术中胆道造影 胆管损伤 学习曲线 1 腹腔镜胆囊切除术后胆漏原因及防治 摘 要 腹腔镜下胆囊切除术（laparoscopic cholecystectomy, LC）是目前创伤 最小的胆囊切除术，具有伤口小、对腹腔内脏器干扰小、术后恢复快、 住院时间短等优点，但 LC 的严重并发症（出血、胆漏）仍时有发生。 胆漏带给患者的不仅是疼痛，还能导致严重感染，脓肿形成，并发多 器官功能衰竭，是具有潜在危及生命风险的并发症。LC 术后胆漏也常 是外科医疗纠纷产生的原因。胆漏一旦发生，都需要予以引流、内镜 下支架置入、或是再次手术行胆道修复或胆道重建术。故熟悉可能导 致胆漏的原因和胆漏的预防显得尤为重要。本文就近年的文献从解剖 变异、急性或慢性炎症、胆囊管残端的处理方面对 LC 胆漏的原因进行 了分析，并且从术前准备、手术技巧及术中特殊方法的应用方面对 LC 胆漏的预防进行了阐述，以期增强对 LC 胆漏的重视，减少 LC 胆漏的 发生。 关键词：腹腔镜胆囊切除术，胆漏，原因，预防 2 CAUSES AND PREVENTION OF BILE LEAK AFTER LAPAROSCOPIC CHOLECYSTECTOMY ABSTRACT Laparoscopic cholecystectomy(LC) is minimally invasive cholecystectomy, It has a small wound, little interference of intra-abdominal viscera, quick recovery, shorter hospitalization time, but its serious complications (bleeding, bile leak) still occurs. Bile leak is not only bring the pain to the patients, but also lead to serious infection, abscess formation, even multiple organ failure, so it’s a potentially life-threaten complication. LC postoperative bile leakage often causes medical disputes. Once bile leak occurs, everyone need to drainage,endoscopic stenting or reoperation to repair reconstitute the bilary duct. So，familiar to the cause of bile leak and its prevention is particularly important. In this paper, the recent literature are collected，to analyze the causes of bile leak from anatomical variations, acute or chronic inflammation, the cystic duct stamp, and the preoperative preparation, surgical techniques and applications of the special methods on the LC to prevent it, so as to enhance the recognition of bile