腹腔镜胆总管切开取石术T管处理的探讨

目的探讨腹腔镜胆总管切开取石术后T管的处理方法。方法1997年7月-2004年10月，我院行腹腔镜胆总管切开取石（laparoscopic common bile duct exploration，LCBDE）、置T管治疗肝外或肝外合并肝内胆管结石420例。明确有胆总管结石后，胆总管切开取石，胆总管一期缝合或置T管。结果胆总管切开取石一期缝合27例（6．4％），置T管393例（93．6％）。术中取尽结石236例（56．2％），术后胆道镜取石184例（43．8％）。209例术后3-4周行经T管胆道造影，无残余结石，拔除T型管。420例随访3个月-6年。平均47．5月，3例复发。结论腹腔镜胆总管切开取石术后T管拔管时间，T管造影无残留结石拔管时间应3—4周，T管造影有残留结石，应于术后6周胆道镜取石后拔管，均闭管2周。

A discussion on the management of T-tube following laparoscopic common bile duct exploration

Objective To explore the management of Ttube following laparoscopic common bile duct exploration.Methods A total of 420 cases of extrahepatic with or without intrahepatic bile duct stones were given laparoscopic common bile duct exploration with T-tube drainage from July 1997 to October 2004 in this hospital.The common bile duct stones were identified and then a laparoscopic choledochotomy was carried out to remove the stones.After stone clearance,the choledochotomy wound was closed with primary duct suture or with T-tube drainage.Results The primary closure of the bile duct was performed in 27 cases((6.4%)) while the T-tube drainage was conducted in 393 cases(93.6%).The stones were completely removed during the operation in 236 cases(56.2%).Stone removal under choledochoscope was required in 184 cases(43.8%) after operation.The T-tubes were removed in 209 cases after a T-tube cholangiogram at 3~4 postoperative weeks showing no residual stones.Follow-up examinations for 3(months ~ 6) years(mean,47.5 months) in 420 cases revealed 3 cases of recurrence.Conclusions After laparoscopic common bile duct exploration,the T-tube should be removed at 3~4 postoperative weeks in the absence of residual stones on T-tube cholangiogram.However,if residual stones were found on T-tube cholangiogram,a choledochoscopy is needed for stone removal at 6 postoperative weeks after the tubes clamped for 2 weeks.