摘要
目的 探索可代替T管引流的胆道手术方法。方法 对 37例胆道探查病人实施逆行穿刺经肝胆道置管引流。在明确胆道远端通畅、结石已取净后 ,在B超导引下逆行穿刺经肝置管外引流 ,均一次穿刺成功。结果 术后引流通畅 ,无脱管及胆漏发生。术后发生气胸及引流管出血各 1例 ,经保守治疗后痊愈。术后平均第8天拔管。胆囊保留 12例 ,术后造影显示肝外胆管无明显狭窄及成角 ,胆囊显影良好。动物实验 :应用 6只仔猪进行经肝胆囊置管引流试验。在术后第 8天肝被膜与壁层腹膜在引流管周围形成致密粘连 ,肝内引流管周围形成一层完整的纤维组织 ,拔管后肝内窦道很快自行闭合 ,阻止胆汁溢出。结论 经肝逆行穿刺置管是安全有效的胆道探查引流术。总胆管内不置T管可使肝外胆管保持正常的生理曲度、术后带管时间缩短、保留的胆囊免受T管压迫及窦道粘连。
Objective To explore an alternative method of T-tube placement after the common bile duct(CBD) exploration.Methods Thirty-seven patients have been performed retrograde transhepatic biliary drainage in placement of T-tube drainage after CBD exploration .Results Bile drainage was 150～800ml/d. Two cases had right pneomothorax and hemobilia which were cured soon after conservative therapy. The drainage tubes were removed on 8th postoperative day. Posoperative cholangiography showed the extrahepatic bile ducts had no strictures or angulations. The preserved gallbladders were well-filled and smooth. Animal experiment: Six piglets were experimented with transhepatic cholecystic intubation. The complete fibrous sinuses were formed in hepatic parenchyma and close adhensions were formed around the drainage tube between the parietal peritoneum and the liver on the 8th postoperative day. After removement of the tubes, the intrahepatic sinuses were soon closed so that bile leakage could be prevented.Conclusion Retrograde transhepatic biliary drainage is a safe and effective method following CBD exploration; Without T-tube in CBD, the extrahepatic duct can keep its normal shape and the preserved gallbladder is prevented from adhension and pression.
出处
《济宁医学院学报》
2001年第3期22-23,共2页
Journal of Jining Medical University
关键词
胆管结石
胆道探查术
逆行经肝胆道引流
Cholelithiasis
Common bile duct exploration
Retrograde transhepatic biliary drainage
