目的探讨介入治疗在肝外伤术后胆道出血和胆瘘并发症中的作用。方法6例肝外伤术后胆道并发症（胆道出血1例，胆瘘3例，胆道出血合并胆瘘2例）采用介入治疗。胆道出血行肝动脉出血分支血管栓塞，胆瘘采用B超引导下穿刺置管引流。结果3 例胆道出血（肝动脉出血）血管成功栓塞，随访3~6个月未再发生出血。5例胆瘘行B超引导下穿刺置管引流，3例引流3~4周痊愈，1例因引流效果差改手术置管引流6周痊愈，1例伴脓肿者手术置管引流2个半月痊愈。结论介入治疗是处理胆道出血和胆瘘并发症的有效措施。
Pancreatic and biliary duct fistula are the most severe and common complication following pancreatoduodenectomy. To prevent this complication, anastomosis should be appropriately performed and drainage of the pancreatic and bile duct is crucial. For proper drainage, the authers designed a cross-shaped tube for both the pancreatic and bile duct drainage, which has been practised on 16 patients with no pancreatic and biliary fistula happened. This new model combines the internal and external pancreatic drainages with biliary T-tube drainage and gives better drainage in practice so that the leakage might be lessened.
【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.
目的评价胆道镜和十二指肠镜在治疗T管拔除后胆瘘中的应用价值。方法对我院2000年5月至2004年12月期间9例采用胆道镜或十二指肠镜下鼻胆管引流（ENBD）治疗T管拔除后胆瘘患者的资料进行回顾性分析。结果本组病例采用胆道镜和十二指肠镜治疗均获成功，无并发症。结论胆道镜和十二指肠镜治疗T管拔除后胆瘘临床疗效可靠，有推广价值。
ObjectiveTo explore the effect of the surgery with laparoscope combined with choledochoscope on plateau hepatic hydatid biliary fistulas. MethodsA total of 100 patients with liver hydatid disease diagnosed between January 2012 and June 2013 were divided into two groups according to the admitting time:laparoscope combined with choledochoscope group (combined group) and laparoscope group, with 50 patients in each group. The therapeutic results of the two groups were compared. ResultsA total of 186 biliary fistulas were found in the combined group during the operation, and there were 5 patients with biliary fistulas after the surgery; while 87 biliary fistulas were found in laparoscope group during the operation and there were 16 patients with biliary fistulas after the surgery. The difference in the occurrence rate of biliary fistulas after surgery between the two groups was significant (χ2=7.294, P=0.007). No infection of incisional wound was found in combined group but 5 infection was found in laparoscope group. The postoperative extubation time in the combined group and laparoscope group was (10.35±3.87) and (27.16±4.58) days, respectively, with a significant difference (t=12.538, P<0.001). ConclusionThe laparoscope combined with choledochoscope is a minimally invasive and safe therapeutic option for plateau hepatic hydatid biliary fistulas.
目的探讨腹腔镜在胆瘘或肠瘘诊治中的应用价值。 方法回顾性分析2008年11月至2013年4月期间广西壮族自治区桂东人民医院和广西壮族自治区民族医院收治的应用腹腔镜诊治的12例胆瘘或肠瘘患者的临床资料。 结果12例患者中胆瘘7例，肠瘘5例，均在手术后发生，均经腹腔镜探查后确诊。12例患者均在腹腔镜下行再次置管引流、缝闭迷走胆管或肠瘘管等处理。手术时间60～170 min、（90±19）min，住院时间3～7 d、（4±1）d，术中出血量20～150 mL、（70±12）mL，术后均顺利康复出院。术后12例患者均获访，随访时间为1个月～5年，平均随访时间为36个月，未发现胆瘘或肠瘘复发者。 结论腹腔镜探查有助于胆瘘或肠瘘的诊断，并可达到微创手术治疗的目的。