Heikkinen Markku, Poikolainen Eero, Kaukanen Erkki, Pääkkönen Matti
Department of Internal Medicine, Unit of Gastroenterology, Kuopio University Hospital, Finland.
Hepatogastroenterology. 2005 Nov-Dec;52(66):1666-7.
A time-honored praxis is to insert a T-tube after open choledochotomy. Well-known complications of T-tube removal include bile leakage, peritonitis, sepsis and postoperative biliary stenosis. A retained T-tube fragment after surgical common bile duct exploration is an uncommon complication of T-tube removal. We report the first case of retained bile duct stones with a whole T-tube jammed into the biliary tree. A 31-year-old female with gallstone disease was operated on. The operation was started by laparoscopy but converted to open laparotomy because of perforation of the gallbladder. T-tube was inserted but several stones remained in the bile duct. Afterwards routine T-tube removal was impossible: the T-tube had become trapped in the common bile duct. This combination of complications was successfully treated by ERCP.
一种由来已久的做法是在开腹胆总管切开术后插入T管。T管拔除的常见并发症包括胆漏、腹膜炎、败血症和术后胆管狭窄。手术探查胆总管后残留T管碎片是T管拔除的一种罕见并发症。我们报告首例整个T管卡在胆管树中并伴有残留胆管结石的病例。一名31岁患有胆结石疾病的女性接受了手术。手术开始时采用腹腔镜手术，但由于胆囊穿孔转为开腹手术。插入了T管，但胆管中仍残留几块结石。此后无法进行常规T管拔除：T管被困在了胆总管中。通过内镜逆行胰胆管造影术（ERCP）成功治疗了这种并发症组合。
