胆总管探查改良自行脱落胆管支架引流与T管引流的比较

Abstract

目的：探讨胆总管探查T管引流的替代方法。方法：胆总管结石患者采用开腹手术，进行胆总管切开探查取石后，通过导丝将蝴蝶结形可自行脱落支架管的远端置入十二指肠，胆总管切口一期缝合。结果：该法治疗31例患者，选择同期完成的放置T管引流30例患者作为对照组；术后平均住院时间分别为9.1 d和14.9 d (P < 0.05)，两组近期并发症及肝功能水平无明显差异。全部支架管自行脱落并随粪便排出，支架排出时间为(13.8 ± 2.91) d。结论：胆总管探查术中在胆总管下端放置蝴蝶结形可自行脱落支架管是T管引流的有效替代方法，可减少T管引流的相关并发症。 Objective: To explore the alternative methods of T-tube drainage in common bile duct exploration. Methods: Open common bile duct exploration (OCBDE) was done in patients with common bile duct (CBD) stones. After extraction of stones, the bowknot-liked stent was pushed into the distal part of the bile duct and lumen of the duodenum over a guide wire. The CBD incision was primarily closed. Results: This technique was used in 31 patients. While T-tube placement was performed in 30 patients of control group. The average postoperative hospital stay was 5.7 and 9.5 days (P < 0.05). There was no difference between the two groups on both the early postoperative complications and liver function. All the stents had been discharged with stool. The average time of the stent discharge was (13.8 ± 2.91) postoperative days. Conclusion: During OCBDE, it was an efficient alternative method to place the bowknot-liked stent at the lower end of common bile duct. It can reduce the complications related to T-tubes.