肝移植中T管的选择性指征：一项随机对照试验结果的前瞻性验证
Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial.
作者信息
López-Andújar R, Maupoey J, Escrig J, Granero P, Vila J J, Ibáñez V, Boscá A, García-Eliz M, Benlloch S, Orbis J F, Montalvá E M
机构信息
HPB Surgery and Transplant Unit, La Fe University Hospital, Valencia, Spain.
HPB Surgery and Transplant Unit, La Fe University Hospital, Valencia, Spain.
出版信息
Transplant Proc. 2019 Jan-Feb;51(1):44-49. doi: 10.1016/j.transproceed.2018.03.133. Epub 2018 Jun 28.
BACKGROUND AND AIMS
T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT.
METHODS
Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs).
RESULTS
In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement.
CONCLUSIONS
We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.
背景与目的
肝移植（LT）相关的胆总管对端吻合术（CCS）中放置T管仍存在争议。本研究旨在验证一项早期前瞻性随机对照试验（RCT）的结果，该试验对比了LT相关的CCS中使用与不使用T管的情况。
方法
前瞻性队列研究。主要结局是胆道并发症（BCs）的总体发生率。
结果
共纳入405例患者，总体中位监测期为29个月（四分位间距：13 - 47个月）。选择性使用T管可降低BCs发生率（23%对13%；P = .003），其中在Clavien-Dindo分类中75%为IIIa型或更低。放置T管与未放置T管的患者总体BC发生率无差异。
结论
我们证实，按照我们前瞻性RCT中确立的原则，在LT相关的CCS中选择性使用橡胶T管，可将BC发生率降低10%且无不良影响，即使纳入的患者发生BC的先验风险高于RCT患者。
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