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拔除T-tube後併發症管理運用於活體肝臟移植患者之臨床經驗

Management of Complications after T-tube Removal in Living Donor Liver Transplantation Patients

摘要


活體肝臟移植手術中,某些狀況下,T-tube之置放可增加膽道吻合的成功率,然T-tube拔除卻會導致膽汁滲漏的併發症產生。目標:分享拔除T-tube產生併發症之處理經驗。方法:本研究為回溯性研究,收集彰化基督教醫院2007-2012年活體肝臟移植病患共125人,膽道吻合手術放置T-tube共30人(24%),拔除T-tube共21人。本研究依據膽汁滲漏及膽汁鬱積狀況,分為有/無併發症組。病患資料收集包括社會人口學特質:性別、年齡、肝臟移植適應症、肝癌病史;術前因子為肝硬化嚴重度(MELD score);術後因子:排斥狀態、膽道感染狀態、T-tube放置時間及膽汁滲漏併發症處理。以Mann-Whitney test比較二組患者之連續型資料,卡方檢定比較類別資料之差異。結果:8人(38.0%)拔除T-tube後產生併發症,T-tube放置時間為6.9±2.2月。7人產生膽汁滲漏,平均於拔除T-tube後37.1分鐘(範圍10-90分鐘)發生腹痛症狀,其中3位患者經由保守療法(禁食及觀察)後,腹痛症狀改善,返家休養;1位患者腹痛症狀加劇,安排腹部電腦斷層檢查診斷膽汁滲漏,並安排膽道內視鏡放置膽道內支架;3位患者於T-tube拔除後30分鐘內,產生嚴重瀰漫性腹痛及腹膜炎症狀,立即安排膽道內視鏡放置膽道內支架。1位患者腹腔內膽汁鬱積,安排經皮穿肝導管引流置放術。結論:膽汁滲漏多數於患者T-tube拔除後1小時內產生。對於T-tube拔除後產生腹膜炎之活體肝臟移植患,膽道內視鏡是一個有效、安全的治療方法,此非手術治療可減緩T-tube拔除後產生之合併症,是一項相當重要的治療方式。本研究結果可提供器官移植單位臨床照顧參考。

並列摘要


T-tube removal in living donor liver transplant patients (LDLT) can occasionally cause a massive biliary leak and peritonitis. Objective: We present our experience with T-tube complication management for living donor liver transplantation patients. Method: A prospective cohort investigation of 125 LDLT patients that including 21 patients with a removal T-tube at a medical center. Result: 8 patients (38.0%) developed T-tube complication that 7 patients biliary leaks developed after its removal; 1 patient biloma and required PTCD. The mean length of the T-tube placed time was 6.9±2.2 month and biliary leaks developed after its removal on the first 37.1 minutes (range 10-90 minutes). 4 patients accepted biliary endoscopy (ERCP) for stent placement on the first day and removed stent by panendoscopy average of 52.7 days (range 29-79 days) that no complications arising during treatment. Conclusion: Biliary leak occurred on the first 1 hour. ERCP is a effective and safe treatment for T-tube removal produced peritonitis in LDLT patients. This nonsurgical treatment can reduce the T-tube removal complication for LDLT patients. These results could provide the organ transplantation center a reference to planning clinical care for T-tube complication management for living donor liver transplantation patients.

被引用紀錄


洪憶雯(2016)。肝病防治方法之關鍵因素〔碩士論文,國立虎尾科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0028-1806201612571000

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