腹腔镜胆总管探查术后T管并发症的原因及防治

目的探讨腹腔镜胆总管探查术后T管并发症的原因及防治措施。方法对2002年～2008年笔者所在医院行腹腔镜胆总管探查T管引流术的378例(其中男性143例,女性235例;年龄17～83岁,平均年龄51.3岁)患者的临床资料进行回顾性分析。结果术后发生T管并发症的有16例(4.23%),其中男性7例,女性9例;年龄20～76岁,平均年龄50.7岁。13例(胆汁漏5例,T管意外滑脱3例,T管扭曲3例,T管引流量异常2例)经保守治疗治愈,1例围T管短臂结石形成者经胆道镜再次取石治愈,2例T管意外滑脱者再次行开腹手术治愈。结论腹腔镜胆道探查术后T管并发症的发生原因主要与手术操作技术、术后处理及患者自身因素相关;提高手术操作技术,术后及时、正确的处理是防治术后T管并发症的关键。

Causes and management of T-tube postoperative complications in laparoscopic common bile duct exploration

Objective To investigate the causes and management measures of T-tube postoperative complications in laparoscopic common bile duct exploration. Methods Clinical data of 378 patients（male 143 and female 235,aged 17 -83 years,mean age 51.3 years） who underwent laparoscopic common bile duct exploration and T-tube drainage in this hospital from 2002 to 2008 were studied retrospectively. Results A total of 16 cases（4.23 %） of T-tube postoperation complications were enrolled,including male 7 and female 9,aged 20 -76 years,mean age 50.7 years. Among them,13 cases（5 biliary fistula,3 T-tube accident spondylolisthesis,3 T-tube distortion and 2 T-tube drainage volume abnormal） were cured by conservative therapy,1 case of stone formation round the short arm of T-tube was cured by second choledochoscopic exploration,and 2 cases of T-tube accident spondylolisthesis were cured by laparotomy. Conclusion It is demonstrated that causes of the T-tube postoperative complications in laparoscopic common bile duct exploration due mainly to the surgical technique,postoperative management and patient＇s condition. Improvement of the surgical technique,timely and correct treatment are the key to manage the T-tube postoperative complications.