肝移植术中不留置T型管指征的探讨

Biliary tract reconstruction without T-tube in orthotopic fiver transplantation

目的探讨肝移植术中不留置T型管，以降低与T管相关胆道并发症的发生率。方法对2004年1月至2006年10月的肝移植患者进行前瞻性临床研究。在此期间内符合指征未留置T管的患者102例，观察本组患者胆道并发症的发生率。结果本组患者均随访6个月以上。胆道并发症的发生率是4．9％（5／102），其中3例为肝内胆管多发性狭窄，均行再次肝移植；2例为肝总管非吻合口狭窄，经ERCP行球囊扩张并放置胆道内支撑管3个月后治愈。结论对符合指征的肝移植患者术中不留置T管是安全的，可避免T管相关并发症，降低胆道总体并发症的发生率。

Objective To probe the indication of biliary tract reconstruction without T-tube in orthotopic liver transplantation. Methods We put forward indications of biliary tract reconstruction without T-tube in orthotopic liver transplantation since January 2004 and there were 102 patients who underwent liver transplantation in our hospital without a T-tube in place after biliary tract reconstruction. The incidence of biliary tract complication was observed in these patients. Results All patients were followed up for more than 6 months. The incidence of biliary tract complication was 4.9 percent（5/102） in this group with 3 patients of intrahepatic diffuse bile duct stenosis necessitating liver re-transplantation. The other 2 patients with common hepatic duct nonanastomotic stenosis were healed by ERCP plus stent placement. Conclusions Biliary tract reconstruction without T-tube placement helps to decrease the incidence of biliary tract complications resulting from the T-tube removal.