胆道探查术中联合胆道镜免置T管术(附136例报告)

Nonuse of T-Tube with the use of Cholanhgioscopes in bile duct exploration(a report of 136 cases attached)

目的探讨胆道探查术中免置T管的可行性与临床意义,提出免置T管的指征。方法胆道探查术中常规使用胆道镜,先查肝内胆管,再查肝外胆管,取尽结石或其他异物后扩张胆道下端,使其能轻松通过18￣20号尿管,并用维生素C酸化肠道,胆管切口用0/3丝线或可吸收线缝合。结果术后胆漏7例(5.15%),残石3例(2.2%),胆道蛔虫1例(0.74%),无胆道狭窄和腹腔感染。结论放置T管有非常重要的临床意义。要免置T管,必须严格掌握好指征;术中使用胆道镜、B超和造影,是降低残石率和提高手术成功率的关键。

[Objective] To investigate the feasibility and chnical significance of free T-tube. [Methods] Cholangioscopes were routinely used in bile duct exploration.check （the bile duct in liver） and then （the bile duct outside the liver） after the stones or others were cleaned. The end of bile duct should be widened so that 18-20 wetic catheter can easily get through. At the same time, acidize the gut with vitamine C and suture the cut with 0/3 silk yarn or absorbable thread. [Results] 7cases suffered from bile leakage after operation. （5.15%）; stones were retained in 3 cases （2.2%） and bellyworm in 1 case （0.74%）. There was no bile duct stricture and peritoneum infection. [ Conclusion] Indwelling T-tube has very important clinical significance~ It is required to monitor the manifestation strictly in order to exclude T-tube. The key to lower the rate of retaining stone and raise the success rate of operation is to apply cholangioscope, B-ultrusound and cholangiography to operations.