Abstract
AIM: To design a double lumen T tube, investigate its hydrodynamic characteristics, and assess its clinical application.
METHODS: A retrospective study was carried out to analyze the data of patients who underwent biliary tract operations with placement of a double lumen T tube from March 1989 to March 2015 at the Department of Hepatobiliary Surgery of Binzhou Medical University Hospital. This study introduced the design, placement and operational method of the double lumen T tube, investigated its hydrodynamic characteristics, analyzed the complications, and assessed its clinical application in biliary tract irrigation, bile culture, cholangiography and enteral nutrition.
RESULTS: Based on the function of double lumen T tube, it was divided into two types: Ⅰ (for biliary irrigation) and type Ⅱ (for enteral nutrition). For type Ⅰ double lumen T tube, the short arm was placed in the extrahepatic bile duct, and the long arm was brought out through the abdominal wall; the inner tube was placed in left or right secondary or tertiary intrahepatic bile duct, with the end outside the body connected to saline for flushing. For type Ⅱ double lumen T tube, the short arm was placed in the extrahepatic bile duct, and the long arm was brought out through the abdominal wall; the inner tube was placed into the duodenum or jejunum through the duodenal papilla or anastomotic stoma, with the end outside the body connected to nutrition solution for enteral nutrition. A total of 1020 patients underwent placement of the double lumen T tube, including 660 who used type Ⅰ and 360 who used type Ⅱ tube. T tube placement time was 5-92 d, with an average value of 23.5 d. Complications included T tube dislocation (2 cases, 0.20%), lumen blockage (12 cases, 1.18%), infection around T tube (23 cases, 2.26%), hemobilia (2 cases, 0.2%), difficulty in removing (1 case, 0.10%), biliary fistula (11 cases, 1.08%), and peritonitis after T tube removal (2 cases, 0.20%). Moreover, 665 cases underwent biliary tract irrigation, and bile culture was performed in 343 cases; the positive rate of bacteria culture was lower than that observed in patients using conventional T tube. In 657 cases who underwent cholangiography, the rate of satisfaction was 98.2%. 358 cases accepted enteral nutrition with type Ⅱ double lumen T tube, and 314 cases underwent simultaneous bile external drainage and pancreatic juice reinfusion.
CONCLUSION: The double lumen T tube is easily made and convenient to use with lower complications. It can be safely used for biliary flushing, bile culture, cholangiography and enteral nutrition after biliary tract operations.
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