Pediatric T-tube in adult liver transplantation:Technical refinements of insertion and removal  

作　　者：Gabriele Spoletini Giuseppe Bianco Antonio Franco Francesco Frongillo Erida Nure Francesco Giovinazzo Federica Galiandro Andrea Tringali Vincenzo Perri Guido Costamagna Alfonso Wolfango Avolio Salvatore Agnes 

机构地区：[1]General Surgery and Liver Transplantation Unit,Fondazione Policlinico Universitario Agostino Gemelli IRCCS,Rome 00168,Italy [2]Digestive Endoscopy Unit,Fondazione Policlinico Universitario Agostino Gemelli IRCCS,Rome 00168,Italy

出　　处：《World Journal of Gastrointestinal Surgery》2021年第12期1628-1637,共10页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND With the increasing use of extended-criteria donor organs,the interest around Ttubes in liver transplantation(LT)was restored whilst concerns regarding T-tuberelated complications persist.AIM To describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult patients.METHODS Data of consecutive adult LT patients from brain-dead donors,treated from March 2017 to December 2019,were collected(i.e.,biliary complications,adverse events,treatment after T-Tube removal).Patients with upfront hepaticojejunostomy,endoscopically removed T-tubes,those who died or received retransplantation before T-tube removal were excluded.RESULTS Seventy-two patients were included in this study;T-tubes were removed 158 d(median;IQR 128-206 d)after LT.In four(5.6%)patients accidental T-tube removal occurred requiring monitoring only;in 68(94.4%)patients Nelaton drain insertion was performed according to our protocol,resulting in 18(25%)patients with a biliary output,subsequently removed after 2 d(median;IQR 1-4 d).Three(4%)patients required endoscopic retrograde cholangiopancreatography(ERCP)due to persistent Nelaton drain output.Three(4%)patients developed suspected biliary peritonitis,requiring ERCP with sphincterotomy and nasobiliary drain insertion(only one revealing contrast extravasation);no patient required percutaneous drainage or emergency surgery.CONCLUSION The use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.

关 键 词：Liver transplantation T-TUBE Kehr Biliary fistula Endoscopic retrograde cholangio-pancreatography Biliary drainage 

分 类 号：R657.3[医药卫生—外科学]