肝移植拔除T管后胆漏的超声介入治疗

目的探讨超声引导下置管引流在肝移植拔除T管后胆漏中的价值，并与其他处理方法作比较。方法2001年8月至2005年3月肝移植行胆管端端吻合或胆肠吻合放置T管患者76例，拔除T管后发生胆漏9例，其中8例患者行超声引导下置管引流，男性7例，女性1例，年龄22-59岁，平均46.7岁。穿刺置管引流术方法为确定穿刺点，在超声引导下采用Seldinger法徒手操作，18G穿刺针穿入积液内，观察到针尖进入积液区后拔出针芯，见液体流出或抽出液体后放入导丝，退出穿刺针放置带内套针的7F直通管，导管进入积液内退出内套针和导丝，局部固定包敷引流管。结果8例患者拔除T管后分别出现剧烈腹痛、发烧、大汗淋漓等症状，超声检查发现均有盆腔积液，积液最大深度范围为3～7cm。8例超声引导下置管引流均一次成功，引流出淡黄色或金黄色胆汁，1d内症状均迅速改善或消失。5～10d后见管内无引流液后拔管，无并发症发生。结论超声引导下置管引流对肝移植拔除T管后胆漏的治疗是安全、有效的，具有重要价值。

Role of interventional ultrasound in the treatment of biliary leaks after T-tube removal in orthotopic liver transplantation

Purpose To evaluate the value of ultrasound-guided catheter drainage in the treatment of biliary leaks after T-tube removal in orthotopic liver transplantation(OLT) and compare with other managements. Methods Between August 2001 and March 2005,76 OLT patients underwent end-to-end common bile duct or bilioenteric anastomosis.Biliary leaks occurred in 9 cases after T-tube removal,8 patients(7 men,1 woman;age 22-59 years,mean 46.7 years) of them were treated with ultrasound-guided catheter drainage.The interventional maneuvers were as follows: after positioning of the deep site of pelvic fluid collections,a 18-gauge needle(Hakko,Japan) was inserted followed by advancing of the guide wire,then a 7-French biliary drainage catheter(Hakko,Japan) was inserted into the fluid collection. Results The most common symptoms after T-tube removal included abdominal pain,fever and sweating.The fluid collection was displayed by ultrasound ranged from 3 to 7 cm in pelvic cavity.All 8 procedures were performed successfully at first attempt and golden leakages were drained.The symptoms were relieved or disappeared rapidly after treatment within 24 hours.The catheters were placed for a duration of 5-10 days and no complications occurred after interventional procedures. Conclusions Ultrasound-guided catheter drainage is safe and effective,and represents an important option in the management of biliary leaks after T-tube removal in OLT patients.