Koivusalo A, Eskelinen M, Wolff H, Talva M, Mäkisalo H
Helsinki University Central Hospital, Fourth Department of Surgery, Finland.
Res Exp Med (Berl). 1997;197(1):53-61. doi: 10.1007/s004330050055.
T-tube-related bile leakage is a considerable problem in liver transplantation but rather rare in surgery of biliary lithiasis. To investigate the effect of T-tube insertion method and material on the intraperitoneal T-tube tract, we performed a choledochotomy and insertion of T-tube (four of silicone, seven of latex, four of silicone with a latex sheath around the long arm) for 2 weeks on 15 piglets (choledochotomy group), and sutured a transected bile duct over a T-tube stent in nine piglets (five silicone, four latex), inserted similarly as in liver transplantations, for 6 weeks. Sixteen patients underwent cholectochotomy and T-tube drainage with a latex T-tube (n = 8) and latex-sheathed silicone T-tube (n = 8) for a median 9 (7-21) days. Histological examination of T-tube tracts in piglets was made, and complications after T-tube removal in the latex T-tube group were compared with those in the latex-sheathed silicone T-tube group. In piglets, latex T-tubes induced better tracts than silicone T-tubes (P < 0.05). Piglets in the choledochotomy group had tracts superior to those in the anastomotic stent group (P < 0.05). There was one bile leakage in the latex T-tube group, and none in the latex-sheathed silicone T-tube group. We conclude that T-tube tract development is affected by both the material and the insertion method of T-tubes. A silicone T-tube with a latex sheath around the long arm may also be a good choice for T-tube material in liver transplantation.
T管相关胆漏在肝移植中是一个相当严重的问题，但在胆管结石手术中较为罕见。为了研究T管插入方法和材料对腹腔内T管通道的影响，我们对15只仔猪进行胆总管切开并插入T管（4只使用硅胶T管，7只使用乳胶T管，4只使用长臂周围带乳胶鞘的硅胶T管），持续2周（胆总管切开组），并对9只仔猪的横断胆管在T管支架上进行缝合（5只使用硅胶，4只使用乳胶），插入方式与肝移植中类似，持续6周。16例患者接受了胆总管切开术，并用乳胶T管（n = 8）和带乳胶鞘的硅胶T管（n = 8）进行T管引流，中位时间为9（7 - 21）天。对仔猪的T管通道进行了组织学检查，并比较了乳胶T管组和带乳胶鞘的硅胶T管组在拔除T管后的并发症。在仔猪中，乳胶T管形成的通道比硅胶T管好（P < 0.05）。胆总管切开组仔猪的通道优于吻合支架组（P < 0.05）。乳胶T管组有1例胆漏，带乳胶鞘的硅胶T管组无胆漏。我们得出结论，T管通道的形成受T管材料和插入方法的影响。长臂周围带乳胶鞘的硅胶T管也可能是肝移植中T管材料的一个不错选择。
