腹腔镜胆总管切开取石术T管处理的探讨

A discussion on the management of T-tube following laparoscopic common bile duct exploration

目的探讨腹腔镜胆总管切开取石术后T管的处理方法。方法1997年7月-2004年10月，我院行腹腔镜胆总管切开取石（laparoscopic common bile duct exploration，LCBDE）、置T管治疗肝外或肝外合并肝内胆管结石420例。明确有胆总管结石后，胆总管切开取石，胆总管一期缝合或置T管。结果胆总管切开取石一期缝合27例（6．4％），置T管393例（93．6％）。术中取尽结石236例（56．2％），术后胆道镜取石184例（43．8％）。209例术后3-4周行经T管胆道造影，无残余结石，拔除T型管。420例随访3个月-6年。平均47．5月，3例复发。结论腹腔镜胆总管切开取石术后T管拔管时间，T管造影无残留结石拔管时间应3—4周，T管造影有残留结石，应于术后6周胆道镜取石后拔管，均闭管2周。

Objective To explore the management of T-tube following iaparoscopic common bile duct exploration. Methods A total of 420 cases of extrahepatic with or without iutrahepatic bile duct stones were given laparoscopic common bile duct exploration with T-tube drainage from July 1997 to October 2004 in this hospital. The common bile duct stones were identified and then a laparoscopic choledochotomy was carried out to remove the stones. After stone clearance, the choledochotomy wound was closed with primary duct suture or with T-tube drainage. Results The primary closure of the bile duct was pertormed in 27 cases （6.4%） while the T-tube drainage was conducted in 393 cases （93.6%）. The stones were completely removed during the operation in 236 cases （56.2%）. Stone removal under choledochoscope was required in 184 cases （43.8%） after operation, The T-tubes were removed in 209 cases after a T-tube cholangiogram at 3 - 4 postoperative weeks showing no residual stones. Follow-up examinations for 3 months - 6 years （mean, 47.5 months） in 420 cases revealed 3 cases of recurrence. Conclusions Aider laparoscopic common bile duct exploration, the T-tube should be removed at 3 - 4 postoperative weeks in the absence of residual stones on T-tube cholangiogram. However, if residual stones were found on T-tube cholangiogram, a choledochoseopy is needed tot stone removal at 6 postoperative weeks after the tubes clamoed for 2 weeks.