T管造影发现胆总管末端狭窄的预后和处理

Management of distal common bile duct stenosis found on T tube cholangiography

目的探讨胆总管探查术后胆总管末端狭窄的预后。方法对1998年1月至2007年1月，64例胆囊切除胆总管探查术后T管造影发现胆总管末端狭窄患者资料进行回顾性分析。其中未做任何处理拔管30例。延长带管时间到6个月，复查T管造影后再拔管14例。7例夹闭T管有症状，其中3例逐渐延长夹管时间后再拔管；另4例一直未能夹管，第·次术后3个月再次手术。行气囊扩张置管支撑半年后拔管13例。结果能够夹闭T管的47例中，41例（87．23％）在2～6年的随访期内没有出现胆道梗阻症状。6例出现胆道梗阻症状，占12．77％。气囊扩张后支撑半年的13例中，7例出现胆道梗阻症状，占53．85％。结论胆总管探查术后，胆道造影发现胆总管末端狭窄；如果能夹闭T管，最妥当的临床处理是可以不做任何处理拔管，密切随访。

Objective To review the management of distal common bile duct stenosis found on T-tube eholangiography. Methods This is a retrospective study on 63 patients who were found to have a distal common bile duct stenosis on T-tube eholangiography after cholecystectomy and bile duct exploration. In 30 patients, the T-tube was removed. In 14 patients, the T-tube was kept draining for 6 month. Seven patients developed biliary obstructive symptoms after the T-tube was spigotted, but in 3 of these patients, the T-tube could finally be removed by prolonging the spigotted time. In the re- maining 4 patients, another operation was required 3 month after the first operation. In 13 patients the T-tube was taken out after 6 months following balloon dilation. Results In 47 patients in whom the T- tube could be s pigotted, 41 patients （87.23 %） did not develop any biliary obstructive symptoms on follow up for 2-6 years, while 6 patients developed biliary obstructive symptoms （12.77%）. In 13 patients who re- ceived balloon dilation, 7 developed biliary obstructive symptoms （53.85%）. Conclusions In patients after common bile duct exploration, if distal common bile duct stenosis was found on T-tube cholangiography, the T-tube could be spigotted and the T-tube could be taken out if no obstructive symptoms developed.