Department of Surgery, St. Josef Hospital Bochum, University Hospital, Gudrunstr. 56, D-44791 Bochum, Germany.
Am J Surg. 2013 Oct;206(4):578-85. doi: 10.1016/j.amjsurg.2013.01.044. Epub 2013 Jul 30.
After pancreatic head resection, bile leaks from a difficult hepaticojejunostomy secondary to a small or fragile common hepatic duct may be reduced by a T tube at the side of the anastomosis.
A retrospective analysis of patients who underwent a difficult hepaticojejunostomy without or with a T tube was performed.
In 48% (55/114) of patients, a T tube was placed at the side of the hepaticojejunostomy; 52% (59/114) did not have a T tube. Bile leaks occurred in 12% (14/114) (9% [5/55] in patients with a T tube vs 15% [9/59] without a T tube, P = .316). Bile leaks were associated with mortality, abscess formation, hemorrhage, and sepsis. Seven percent (8/114) of patients required revisional laparotomy (2% [1/55] with a T tube vs 12% [7/59] without a T tube, P = .036). Mortality was not different between the groups. Minor T-tube-associated complications occurred in 15% (8/55) without major complications.
Augmentation of anastomosis with a T tube cannot prevent biliary leakage but does reduce the severity of bile leaks, resulting in less reoperations.
在胰头切除术后，由于小而脆弱的肝总管，胆漏可能会从困难的胆肠吻合口漏出，可以通过在吻合口旁放置 T 管来减少。
对行困难胆肠吻合术且未放置或放置 T 管的患者进行回顾性分析。
在 114 例患者中，有 48%（55/114）的患者在胆肠吻合口旁放置了 T 管；52%（59/114）的患者未放置 T 管。胆漏发生在 12%（14/114）的患者中（有 T 管的患者为 9%[5/55]，无 T 管的患者为 15%[9/59]，P=.316）。胆漏与死亡率、脓肿形成、出血和感染有关。7%（8/114）的患者需要再次剖腹手术（有 T 管的患者为 2%[1/55]，无 T 管的患者为 12%[7/59]，P=.036）。两组患者的死亡率无差异。无 T 管组发生 15%（8/55）的轻微 T 管相关并发症，无重大并发症。
T 管加强吻合口并不能预防胆漏，但可减轻胆漏的严重程度，从而减少再次手术。
