Biliary Tract Reconstruction After Liver Transplantation With Or Without T-Tube: A Systematic Review

Objective:To determine the effectiveness and safety of T-tube in patients with biliary tract reconstruction after liver transplantation and provide the proof of evidence-based pharmacy. Methods:We searched MEDLINE(1966-2008),PUBMED(1966-2008),CNKI(1996-2008),The Cochrane Library(Issue 2,2008),CBMdisc(1980-2008) and so on, and data were extracted and assessed by reviewers independently according to Cochrane standard,RevMan 4.2 software was used for statistical analysis. Results:Seven randomized controlled studies met the inclusion criteria,500 patients were included. We conducted subgroup analyses based on the outcome measures.The meta-analysis showed:to compaire with no T-tube, biliary tract reconstruction after liver transplantation with T-tube had statistical difference in the leaks of nonanastomotic and added hospital stay owing to primary complications. [RR=7.70 95%CI(1.37,43.21), RR=6.30 95%CI(4.99,7.61)].No significant differences were noted between the treatment group and the control group for all the other outcome measures.Including the rates of biliary complications,surgical interventions,cholangitis,case fatality rate,bile duct bending,and mean hospital stay. [RR=2.65 95%CI(0.97,7.25), RR=1.86 95%CI(0.45,7.67), RR=2.19 95%CI(0.70,6.87), RR=1.24 95%CI(0.65,2.37) , RR=3.06 95%CI(0.31,30.08), RR=3.00 95%CI(-2.19,8.19)].Conclusion:for the leaks of non anastomotic and added hospital stay owing to primary complications,no T-tube group appears to be as safe as T-tube group, No significant differences were noted between the treatment group and the control group for all the other outcome measures(P>0.05). Using T-tube or not should depend on the actual conditions of bile duct.Due to the low methodological quality of trials included,more RCTs of high quality and large scale are required.