Retrograde transhepatic biliary drainage in surgical treatment of biliary tract stones / 中国现代普通外科进展

ABSTRACT

Objective: To explore the alternatives for T-tube placement in surgical treatment of bile duct stones.Methods: Fourty-nine patients with bile duct stones have been performed retrograde transhepatic biliary drainages(RTBD)since 1991.Among them,37 cases were placed the drainage tubes through the right hepatic lobes by retrograde punctures;the other 12 cases with intrahepatic stones were placed the drainage tubes through the intrahepatic bile duct stumps following partial hepatectomies.All the CBD exploration incisions were primarily closed.Results: (1)RTBD by retrograde punctureTwo postoperative complications(5.4%,pneumothorax and biliary hemorrhage)occured.Both cases were cured by medical therapy.The drainage tubes were removed on the 8th postoperative day.(2)RTBD through intrahepatic ductsFour cases had residual stones(30%)which had been cleared up by combination of extraction and intraluminal lithotripsy.Nineteen cases(38.8%)had the gallbladders preserved.Postoperative cholangiographies showed that all the gallbladders were smooth and well-filled and the extrahepatic bile ducts were in normal shapes.Extrahepatic bile ducts and all the preserved gallbladders did not show any deformity and stone formation by ultrasonography during 6 months to 9 years'following-up.Conclusion: RTBD by retrograde puncture has the advantage of shorter period of bearing drainage tubes;RTBD through intrahepatic duct stump after partial hepatectomy makes it easier to extract postoperative residual stones.Both methods have no negative impacts on the anatomies of both the extrahepatic bile duct and the gallbladder.