经T管介入治疗胆管疾病术后胆管狭窄的临床应用

目的探讨经T管途径介入治疗胆管疾病外科术后胆管狭窄的临床价值。方法回顾性分析2005年2月—2012年12月因胆管疾病接受外科手术并留置T管引流后继发胆管狭窄的19例患者的临床资料，其中男12例，女7例，年龄45～70岁，平均57．4岁。原发疾病分别为肝门部胆管癌8例，胆总管结石6例，胆囊癌5例。经T管造影证实，12例T管短臂下支开口狭窄或梗阻，5例T管上支和下支均狭窄或梗阻，1例T管上支开口狭窄，1例T管上支开113狭窄和胆管瘘继发胆汁瘤。所有患者在数字减影血管造影（DSA）透视下经T管途径予以介入治疗。结果6例经T管下支置人多侧孔导管予以胆汁内引流，4例经T管上支置入pigtail导管予以外引流，3例经T管置入球囊导管扩张上、下支狭窄，2例经T管下支置人镍钛合金胆管支架，2例经T管下支置入镍钛合金可回收胆管支架，1例采用经皮肝穿刺胆管引流（PTCD）联合经T管置入导管行胆汁内转流，1例经T管置入导管引流胆汁瘤并予弹簧圈栓塞胆管瘘。术后胆管梗阻症状明显缓解，随访1—6个月，2例因肿瘤衰竭死亡；2例患者出现再狭窄，予以再次PTCD引流。结论对于胆管疾病外科术后留置T管再发胆管狭窄的患者，可经T管途径采用置管引流、球囊扩张、支架置入等介入技术再次治疗，该技术操作简便、安全、微创。

Clinical application of the T - tube pathway intervention for the treatment of postoperative biliary tract stenosis

Objective To investigate the clinical value of the T - tube pathway intervention for the treatment of postoperative biliary tract stenosis. Method The clinical data of 19 patients who underwent surgical and indwelling T - tube drainage for the treatment of postoperative biliary duct stnosis from 2005 to 2012 were analyzed retrospectively. Of the 19 patients, 12 were males and 7 were females, aged 45 to 70 years with a mean of 57.4 years. The primary diseases were hilar cholangiocarcinoma in 8 cases, common biliary tract stones in 6 cases, carcinoma of gallbladder in 5 cases. By T tube cholangiography, 12 cases were confirmed of stenosis in the short arm of the T - tube or obstruction of the lower branch openings, 5 cases of stenosis or obstruction in the upper and lower branches of T - tube, 1 case of stenosis in the upper branch openings, 1 case of stenosis in the upper branch openings of the T - tube and biliary tract fistula with sec- ondary biloma. All the patients were treated by digital subtraction angiography （DSA） - guided T - tube pathway intervention. Results Internal biliary drainage by inserting a catheter with multiple side holes through the lower branch of the T - tube was performed in 6 cases. External biliary drainage by inserting a pigtail catheter through the upper branch of the T - tube was performed in 4 cases. Balloon catheter was inserted through the T - tube for dilation of stenosis in the upper and lower branches in 3 cases. Nickel titanium alloy cholangio - stent was inserted through the lower branch of the T - tube in 2 cases. Recoverable nickel titanium alloy cholangio - stent was inserted through the lower branch of the T - tube in 2 cases. Percutaneous transhepatic cholangial drainage （PTCD） combined with insertion of drainage catheter into the biliary tract through the T - tube for internal biliary bypass was performed in 1 case. T - tube drainage of the biliary tract into the biloma and coil embolization of duct fistula were performed in 1 case. Biliary tract obstruction symptoms were relieved after operation. 1 to 6 months follow - up showed that 2 cases died due to failure, restenosis occurred in 2 cases who received PTCD drainage again. ConclusionCatheter drainage, balloon dilation, stent placement, and other interventional treatment through the T -tube are preferable for the treatment of postoperative biliary tract stenosis following T - tube indwelling, which is simple, safe and minimally invasive.