探讨利用导丝调整异常T管的位置并二次置入胆道引流管治疗肝胆手术术后胆汁漏的有效性及安全性。

回顾性分析2018年1月至2020年1月于我院在DSA引导下经T管调管并二次置入胆道引流管治疗肝胆术后胆汁漏的4例患者资料。经T管引入导丝导管，导丝导管配合，调整异常的T管并进入肝内胆管内，经导丝引入8.5F COOK胆道外引流管置于肝内胆管，行胆道负压外引流。总结评价治疗效果。

术后4例患者负压引流管引流通畅，胆汁漏逐渐停止，腹腔内感染得到控制。术后1个月复查造影，见引流管位置正常，无造影剂外溢至腹腔，2个月拔除T管及胆道引流管后，患者无特殊不适。随访1年，患者病情未再反复。

DSA引导下经T管调管并二次置入胆道引流管是治疗肝胆手术术后胆汁漏的安全有效的方法，可避免再次外科手术，减轻患者痛苦。

To investigate the efficacy and safety of using guide wire to adjust the position of abnormal T-tube and replacing biliary drainage tube in the treatment of bile leakage after hepatobiliary surgery.

Retrospective analysis was performed on 4 patients with bile leakage after hepatobiliary surgery who were treated by T-tube adjustment and secondary biliary drainage tube placement under the guidance of DSA in Xiang Zhou District People's Hospital from January 2018 to January 2020. The guide wire and catheter were introduced through the T-tube, and the guide wire and catheter were coordinated to adjust the abnormal T-tube and enter the hepatic bile duct. The 8.5F Cook external biliary drainage tube was introduced through the guide wire and placed into the intrahepatic bile duct for biliary negative pressure external drainage. Summarize and evaluate the therapeutic effect.

Postoperatively, the negative pressure drainage tube was unblocked in four patients, the bile leakage gradually stopped, and the intra-abdominal infection was controlled. One month after the operation, the radiographic examination showed that the drainage tube was in normal position, and no contrast agent spilled into the abdominal cavity. Two months after the operation, the T-tube and biliary drainage tube were removed, and the patients had no any discomfort. Followed up for1 year, the patient's condition did not recur.

The secondary placement of biliary drainage tube through T-tube under the guidance of DSA is a safe and effective method for the treatment of postoperative bile leakage after hepatobiliary surgery, which can avoid the recurrence of surgical operations and relieve the pain of patients.