目的 探讨胆总管探查术后胆总管末端狭窄的预后.方法 对1998年1月至2007年1月,64例胆囊切除胆总管探查术后T管造影发现胆总管末端狭窄患者资料进行回顾性分析.其中未做任何处理拔管30例.延长带管时间到6个月,复查T管造影后再拔管14例.7例夹闭T管有症状,其中3例逐渐延长夹管时间J后再拔管；另4例一直未能夹管,第一次术后3个月再次手术.行气囊扩张置管支撑半年后拔管13例.结果 能够夹闭T管的47例中,41例(87.23％)在2～6年的随访期内没有出现胆道梗阻症状.6例出现胆道梗阻症状,占12.77％.气囊扩张后支撑半年的13例中,7例出现胆道梗阻症状,占53.85％.结论 胆总管探查术后,胆道造影发现胆总管末端狭窄；如果能夹闭T管,最妥当的临床处理是可以不做任何处理拔管,密切随访.%Objective To review the management of distal common bile duct stenosis found on Ttube cholangiography.Methods This is a retrospective study on 63 patients who were found to have a distal common bile duct stenosis on T-tube cholangiography after cholecystectomy and bile duct exploration.In 30 patients,the T tube was removed.In 14 patients,the T tube was kept draining for 6 month.Seven patients developed biliary obstructive symptoms after the T-tube was spigotted,but in 3 of these patients,the T-tube could finally be removed by prolonging the spigotted time.In the remaining 4 patients,another operation was required 3 month after the first operation.In 13 patients the T tube was taken out after 6 months following balloon dilation.Results In 47 patients in whom the Ttube could be spigotted,41 patients (87.23％) did not develop any biliary obstructive symptoms on follow up for 2 6 years,while 6 patients developed biliary obstructive symptoms (12.77％).In 13 patients who received halloon dilation,7 developed biliary obstructive symptorns (53.85％).Conclusions In patients after common bile duct exploration,if distal common bile duct stenosis was found on T-tube cholangiography,the T-lube could he spigotted and the T-tube could be taken out if no obstructive symptoms developed.
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