ABSTRACT

Objectives: Biliary tract reconstruction with or without T-tube is commonly used in orthotopic liver transplantation (OLT). However, the efficacy and safety of T-tube usage remain controversial. This meta-analysis was conducted to assess the latest evidence of clinical outcomes.

Methods: Embase, Cochrane Library, PubMed, and Web of Science were systematically searched from inception to 20 January 2021 for eligible studies. The analyses were performed using Review Manager and Stata.

Results: A total of 24 trials involving 3320 participants were included in the meta-analysis. Compared with the no T-tube group, there was a higher incidence of overall biliary complications (OR:1.54; 95%CI, 1.06–2.24; P = 0.02), bile leaks (OR:2.34; 95%CI,1.57–3.48; P < 0.0001), cholangitis (OR:2.78; 95%CI,1.19–6.51; P = 0.002), and longer cold ischemia time (MD:22.27; 95%CI,0.80–43.74; P = 0.04) in the T-tube group. Furthermore, the no T-tube group had significantly higher odds of biliary strictures than the T-tube group (OR:0.60; 95%CI, 0.47–0.78; P = 0.0001).

Conclusion: T-tube is still not routinely recommended, but is a good choice for OLT patients at high risk of biliary strictures. Notably, the higher rate of biliary complications in the T-tube group did not translate into an increase in endoscopic or re-operative interventions.

摘要

目的：有或没有 T 管的胆道重建通常用于原位肝移植 (OLT)。然而，使用 T 管的有效性和安全性仍存在争议。这项荟萃分析旨在评估临床结果的最新证据。

方法：从成立到 2021 年 1 月 20 日，系统地搜索了 Embase、Cochrane 图书馆、PubMed 和 Web of Science，以寻找符合条件的研究。使用 Review Manager 和 Stata 进行分析。

结果：荟萃分析共纳入 24 项试验，涉及 3320 名参与者。与无T管组相比，总胆道并发症（OR：1.54；95%CI，1.06～2.24；P  =0.02）、胆漏（OR：2.34；95%CI，1.57～3.48）发生率更高在T  _ _ _  _ _  -管组。此外，无 T 管组的胆道狭窄几率显着高于 T 管组（OR：0.60；95% CI，0.47-0.78；P  = 0.0001）。

结论：T 管仍不被常规推荐，但对于胆道狭窄高危的 OLT 患者来说是一个不错的选择。值得注意的是，T 管组较高的胆道并发症发生率并未转化为内窥镜或再手术干预的增加。