改进型三腔引流T管在胆道探查手术中的应用(附33例报道)

Effect of the modified three-cavity drainage T-tube following the bile duct exploration(with 33 cases reported)

目的 介绍一种改进型三腔引流T管及在胆道探查手术中的应用。方法 33例肝内外胆管结石病人行胆道探查取石、改进型三腔T管引流术,术后经三腔T管冲洗和造影,评价其效果。结果 全组33例术后恢复顺利,无胆漏、胆管炎等并发症,术后平均住院时间为7.5天。其中伴胆道出血者6例,自内支架管冲洗1-3天后控制出血;4例术后5-7天经三腔T管造影发现残留结石,再次以胆道镜成功取净取石。33例患者均获得随访4-42月,B超、上腹部CT及MRCP检查,未发现结石复发,无胆总管狭窄。结论 胆总管探查术后应用改进型三腔引流T管,解决了传统T管引流的一些弊端,能更有效地控制胆道感染和胆道出血,术后胆道造影更清晰,操作简单易行。

Objective To investigate the effect of a modified three-cavity drainage T-tube on clinical application following bile duct exploration.Methods Thirty-three patients with intra-and extra-hepatic bile duct stones underwent open surgical treatment through common duct exploration and removal of biliary stones.Biliary flushing and T-tube imaging were done by using a modified threecavity T-tube after operation.Results All the postoperative courses were uneventful,no bile leakage,cholangitis occurred in the patients.Of 33 cases,Biliary bleeding were controlled completely in 6 cases by postoperative T-tube flushing for 1-3 days.The retained calculus were discovered in 4 cases by Ttube imaging in 5-7 days after operation,and cured using choledochoscopes to remove all the retained calculus.The average length of hospital stay was 7.5 days after surgery.All cases were followed up for4-42 months.B-ultrasonography,abdominal CT and magnetic resonance cholangiopancreatography found no Bile duct stones recurrent or common bile duct stricture.Conclusion The application of the modified T-tube showed good clinical effect in patients underdone common duct exploration.