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胆管狭窄 T 管放置效果的回顾性临床研究。

Retrospective Clinical Study of the Effects of T-Tube Placement for Bile Duct Stricture.

机构信息

Department of Surgery, Hitit University School of Medicine, Erol Olçok Training and Research Hospital, Çorum, Turkey.

出版信息

Med Sci Monit. 2017 Sep 8;23:4328-4333. doi: 10.12659/msm.906630.


DOI:10.12659/msm.906630
PMID:28883388
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5601390/
Abstract

BACKGROUND T-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement. MATERIAL AND METHODS Retrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis. RESULTS Of the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4-21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found. CONCLUSIONS A retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications.

摘要

背景:在胆囊切除术中,T 型管置入胆总管(CBD)是一种替代胆管重建的手术方法,适用于胆石症或胆囊-胆管结石病。本回顾性临床研究旨在探讨 T 型管置入后的迟发性并发症发生率。

材料与方法:回顾性分析确定了 35 例在胆囊切除术中放置 T 型管的患者。收集了手术适应证、患者人口统计学和临床症状等临床资料。超声(US)用于测量胆总管(CBD)、肝内胆管的直径以及 CBD 内是否存在结石。实验室检查数据包括天冬氨酸氨基转移酶-血小板比值指数(APRI),该指数是一种非侵入性方法,用于评估胆汁淤积和肝纤维化。

结果:在纳入研究的 35 例患者中,33 例(94.3%)因胆石症而行开腹胆囊切除术、CBD 探查和 T 型管置入。其余 2 例(5.7%)因 CBD 损伤而行 CBD 一期修复和 T 型管置入。T 型管置入后平均随访时间为 69 个月。在 T 型管置入患者中,CBD 直径为 4-21mm,20 例(57.1%)正常,15 例(42.9%)扩张,平均 CBD 直径为 8.91±4.82mm。未发现 CBD 残余或复发结石,也未发现胆管炎或胆汁淤积的临床或实验室证据。

结论:在单一外科中心进行的回顾性临床研究表明,在开腹胆囊切除术和 CBD 探查期间放置 T 型管是一种安全的手术方法,不会导致迟发性并发症。

相似文献

[1]
Retrospective Clinical Study of the Effects of T-Tube Placement for Bile Duct Stricture.

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[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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Medicine (Baltimore). 2015-7

引用本文的文献

[1]
Does early application of needle-knife sphincterotomy (NKS) in patients with difficult biliary cannulation increase the risk of postERCP pancreatitis? A single centre study.

Pak J Med Sci. 2023

[2]
Pitfalls and promises of bile duct alternatives: A narrative review.

World J Gastroenterol. 2022-10-21

[3]
Proteobacteria Acts as a Pathogenic Risk-Factor for Chronic Abdominal Pain and Diarrhea in Post-Cholecystectomy Syndrome Patients: A Gut Microbiome Metabolomics Study.

Med Sci Monit. 2019-9-29

[4]
Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study.

Ann Med Surg (Lond). 2019-5-31

[5]
A Novel Remote-Controlled Injection Device for T-Tube Cholangiography: A Feasibility Study in Canines.

Med Sci Monit. 2019-3-18

[6]
Temporary CBD Stenting with a Nelaton Tube Is a More Practical and Safer Option Than T-Tube Drainage after Conventional CBD Exploration for Choledocholithiasis.

HPB Surg. 2018-9-13

[7]
Financial Aspects of Bile Duct Injuries.

Med Sci Monit. 2017-11-4

本文引用的文献

[1]
Biliary tract anatomy and its relationship with venous drainage.

J Clin Exp Hepatol. 2014-2

[2]
Long-term consequences of bile duct injury after cholecystectomy.

J Visc Surg. 2014-9

[3]
Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center.

Ann Surg Treat Res. 2014-1

[4]
Postcholecystectomy bile duct injury and its sequelae: pathogenesis, classification, and management.

Indian J Gastroenterol. 2014-5

[5]
Initial large diameter of common bile duct is associated with long-term dilatation of bile duct after endoscopic extraction of stones.

J Dig Dis. 2014-1

[6]
T-tube drainage versus primary closure after laparoscopic common bile duct exploration.

Cochrane Database Syst Rev. 2013-6-21

[7]
Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis.

Surg Endosc. 2013-11

[8]
Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center.

J Am Coll Surg. 2013-3-18

[9]
The fading role of T-tube in laparoscopic choledochotomy: primary choledochorrhaphy and over pigtail j and endonasobiliary drainage tubes.

J Laparoendosc Adv Surg Tech A. 2010-12

[10]
Comparative evaluation of two laparoscopic procedures for treating common bile duct stones.

Cell Biochem Biophys. 2011-4

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