胆总管结石术后T管拔除前T管造影的临床价值

Clinical value of T-tube cholangiography before T-tube removal after choledocholithiasis

目的探讨胆总管结石行胆总管探查取石术后拔除T管前常规行T管造影的临床价值。方法回顾性分析128例经胆总管探查+T管引流术治疗的胆总管结石患者临床资料,所有患者拔管前均行肝功+B超及T管造影检查。对比分析肝功+B超检查与T管造影检查对胆总管残余结石诊断价值。结果 T管造影后共21例患者出现不同程度的不良反应,占16.4%。肝功+B超检查与T管造影检查评估胆总管残余结石结果无明显差异(P=0.065);两种方式一致性显著(Kappa值:0.682);两种方法对胆总管残留结石的诊断敏感度无显著差异(P=1.000)。结论胆总管结石术后患者T管拔除前的T管造影检查不需要常规进行。拔除T管前充分评估术后恢复情况、肝功及B超结果,有疑问时再进一步T管造影或MRCP等检查是安全可靠的。

Objective To discuss the clinical value of T-tube cholangiography before T-tube removal in patients after choledocholithiasis. Methods A retrospective analysis of the clinical data of 128 choledocholithiasis patients undergoing common bile duct exploration and T-tube drainage after choledocholithotomy. All the patients underwent liver function ＋Bultrasonography and T-tube angiography before extubation. The diagnosis results of residual choledocholithiasis by assessing combined liver function＋B-ultrasound with T-tube cholangiography were compared. Results After T-tube cholangiography, 21 patients had different degree of adverse reactions, which accounted for 16.4%. Evaluating residual stones results by liver function＋B-ultrasound and T-tube cholangiography had no significant difference （P=0.065）. Two kinds of methods had a significant consistency （Kappa value=0.682）. The diagnostic sensitivity had no significant difference between the two methods of residual common bile duct stones （P=1.000）. Conclusion After choledocholithiasis, T-tube cholangiography before T-tube removal is not required. It is safe and reliable to evaluate the postoperative recovery, liver function and B ultrasound before T-tube removal, and to further T-tube angiography or MRCP when in doubt.