肝移植术后是否留置T管对胆道并发症影响的研究

Study on the effect of indwelling T tube on biliary complications after liver transplantation

目的本研究就两种方法留置T型管与不留T型管在胆管端端吻合成人经典式原位肝移植中应用的可行性及安全性进行了探讨。方法将60例肝移植患者分成两组,实验组在术中留置T型管,而对照组则未留置。分别对两组术前及术后1天,1个月和3个月的肝功、肾功、凝血因子进行收集,并对术后的治疗结果,生存率进行了收集和分析。结果实验组死亡5例,生存时间最长1681天,至随访结束时尚活;对照组死亡3例,生存时间最长1381天,至随访结束时尚活。对于肝功两组患者比较,差异无统计学意义(P>0.05),而在手术前后两组肾功差异也不显著(P>0.05)。凝血指标两组比较差异有统计学意义(P<0.05)。结论肝移植术留置T型管与不留T型管对患者无明显影响。但不放置T管是有很大挑战性的技术,这就要求手术医师必须有更高的缝合技术,具备丰富的肝胆道外科经验和严格选择手术适应证,应以放置T管引流为妥,以避免错误的治疗策略造成不良后果。

Objective To discuss the security and the feasibility of two methods of indwelling and no indwelling T tube in end to end anastomosis of the bile duct in adult classic orthotopic liver transplantation. Methods 60 cases of liver transplantation were divided into two groups,T tubes were detained in the operations in the experimental group, while in the control group were not. The liver function,renal function, blood coagulation factors of two groups before and after operation 1 day, 1 month and 3 months were collected, and the treatment results and survival rates of postoperative were collected and analyzed. Results In the experimental group 5 cases died,the longest live time of the cases who still were lived by the end of follow-up visit was 1681 days. And in the control group,3 cases died,the longest live time of cases who were lived by the end of follow-up visit was 1381 days,There were no differences of liver and kidney functions （P〈0. 05）and were statistically significance in the blood coagulation factors （P〉0. 05） between the two groups before and after operation. Conclusion There was no significantly influence between the T-tube detaining or not. But there is a great challenge of no detaining T tube in operation,which requires the surgeon must have higher suture technique,rich experience and strict selection of surgical indications. So it is better to indwell T tube properly to avoid the adverse consequences caused by wrong treatment strategies.