腹腔镜胆道探查术后拔除T管致胆汁性腹膜炎的思考

Reflection on the causes of biliary peritonitis following T tube removal after laparoscopic biliary exploration

目的:探讨腹腔镜胆道探查术后T管拔除后引起胆漏致腹膜炎的原因及处理措施。方法:分析47例胆总管结石行腹腔镜胆道探查+T管引流手术的患者术后拔除T管的资料。结果:47例患者均在腹腔镜下行胆道探查术,术中均放置T管,4-0可吸收縫线间断缝合胆总管,术后6~8周经T管窦道行造影提示肝内外胆管无结石残留,予以拔除T管,有3例出現胆漏,经保守治疗无效,患者出现胆汁性腹膜炎体征,均行开放手术,其中2例予以重置T管,1例行T管窦道縫合术,3例患者顺利出院,重置T管患者术后4周拔除T管。结论:为了尽可能减少腹腔镜胆道探查术后T管拔除所引起的胆漏,建议术中尽量使T管垂直于腹壁以利子引出路径最短,另外T管拔除时间尽可能延长至术后8周以上。

Objective:To investigate the causes and management of biliary peritonitis caused by bile leakage after removal of T tube after laparoscopic biliary exploration.Methods:The data of 47 patients with choledocholithiasis who underwent laparoscopic bile duct exploration and T-tube drainage were reviewed.Results:41 patients with choledocholithiasis underwent laparoscopic operation,and T tube was retained after operation.6 weeks after operation,routine T tube radiography showed no residual stones and T tube was removed.3 cases had bile leakage and were ineffective after conservative treatment,the patients with signs of biliary peritonitis underwent open operation,including 2 cases of T tube replacement,1 case of T tube sinus suture and 3 cases were discharged smoothly.In patients with T-tube replacement,the T-tube was removed at the end of the week after operation.Conclusion:In order to minimize the bile leakage caused by T-tube removal after laparoscopic bile duct exploration,it is recommended that the T-tube should be perpendicular to the abdominal wall as far as possible to minimize the extraction path,and the removal time of T-tube should be prolonged to more than 8 weeks after operation.