Biliary T-tube Drainage Research Articles

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Comparison of the disposable bag replacement time of biliary T-tube drainage

Objective To compare the replacement time of normal and anti-reflux disposable drainage bag for the risk of infection in patients with biliary T-tube drainage, and to explore the most suitable frequency which patients can get the most benefits.Methods Totals of 144 patients with routine T-tube drainage and the negative culture results of biliary bile were randomly divided into three groups by random number table method. Group A and group B used ordinary disposable drainage bag, while group A changed it every day and group B changed it once a week.Group C used the disposable anti-reflux drainage bag and replaced it once a week.The extraction of bile from drainage bag was used to do the bacteriological monitoring and the results were compared among the three groups.Results There was no significant difference in the bacterial culture among the three groups at the 5th day and 10th day after the drainage （χ2 =0.51, 1.64, respectively;P 〉0.05）.The replacement frequency of the three groups were statistically significant （F=1 379.17,P〈0.01）.The cost of changing drainage bag in three groups had statistically significant difference （ F =229.19, P 〈0.01 ）. Conclusions Patients with biliary T-tube, who use the ordinary disposable bags and change it weekly have similar infection rate as the anti-reflux drainage bag, what’ s more, it can reduce the costs of patients and the workload of nurses. Key words: Biliary track; T-tube drainage; Disposable drainage bag; Replacement time

Human biliary metabolites of isotretinoin: identification, quantification, synthesis, and biological activity

1. The metabolites of isotretinoin (13-cis-retinoic acid, Accutane) were investigated in the bile of two patients with biliary T-tube drainage after administration of a single, oral, 80-mg dose of 14C-isotretinoin. Radioactivity measurements showed that the two patients excreted 22.7 and 17.1% of the dose in their bile in 4 days. 2. The two major drug-related components in the bile were identified as the glucuronide conjugates of 4-oxo-isotretinoin and 16-hydroxy-isotretinoin. Two minor components were identified as the glucuronide conjugates of isotretinoin and 18-hydroxy-isotretinoin. 3. H.p.l.c. analyses of Glusulase-treated bile samples indicated that the glucuronides of isotretinoin and the two major metabolites accounted for about 48% and 44% of the total radioactivity in the bile of the two patients. 4. Racemic 16-hydroxy-isotretinoin was synthesized and evaluated for its effect on human sebocytes in vitro. This metabolite and the other major metabolites of isotretinoin were less active than isotretinoin in inhibiting the proliferation of the sebocytes.

Studies on the metabolism of perhexiline in man.

We have studied the disposition of perhexiline and its two major metabolites, M1 and M3, in healthy volunteers and in patients with biliary T-tube drains after cholecystectomy. In healthy volunteers the genetic control for impaired hepatic oxidation is identical for debrisoquine, sparteine, and perhexiline. Poor metabolizers demonstrate markedly reduced production and excretion of the major metabolite, M1. Their production of M3 is also reduced, but to a lesser degree than for M1, confirming substrate stereoselectivity by hepatic oxidases. Biphasic urinary elimination of M1 and M3 is seen in intact extensive oxidizers, whereas only the first phase is apparent in patients with biliary T-tube drainage. This suggests the possibility of enterohepatic recycling of these compounds, which may account for their prolonged elimination. More than 90% of an ingested dose of perhexiline maleate remains unaccounted for at 24 h after ingestion, even in extensive metabolizers. A careful, radiolabelled tissue-distribution study is warranted to elucidate the complicated metabolic fate of perhexiline.

Patterns of Postoperative Biliary T-Tube Drainage

Patterns of Postoperative Biliary T-Tube Drainage

Kinetics of mezlocillin in patients with biliary t-tube drainage.

Kinetics of mezlocillin in patients with biliary t-tube drainage.

Elimination of azlocillin in patients with biliary t-tube drainage.

The pharmacokinetic of azlocillin was followed in five elderly patients after biliary surgery. Total clearance was 138.6 +/- 17.7 ml/min when 2.0 g was given as an i.v. bolus injection. The half-life of the beta-phase averaged 110 min. The total clearance and the half-life of azlocillin were influenced by slight impairment of renal function (creatinine clearance 59.4 +/- 13.6 ml/min). In patients with normal liver function biliary excretion of the drug amounted to 5.3 +/- 2.8% of the dose (n = 3) and the kinetics of biliary excretion were linear. In contrast, in two patients with impaired liver function biliary excretion was 0.2% and 0.5% of the dose, and kinetic analysis of biliary excretion rates revealed at least one zero order step in the excretion process. Renal excretion of the drug amounted to 45.0 +/- 17.7% of the dose, which means that 50% of the total clearance of azlocillin has to be accounted for by metabolic clearance.

BILIARY EXCRETION OF DIAZEPAM IN MAN

In a study of diazepam metabolism, diazepam 10 mg was administered i.m. to four patients who had biliary T-tube drainage. Blood and bile diazepam metabolite concentrations were measured for 12 hr. The expected fluctuations in blood diazepam concentrations were seen, and conjugated diazepam metabolites were present in human bile. Bile diazepam concentrations were insufficient to account for an enterohepatic circulation.

Reinvestigation of the metabolism of estriol-16 glucosiduronate in subjects with biliary T-tube drainage.

ABSTRACT The biliary and urinary metabolites of 3H-estriol-16 glucosiduronate (E3-16G) were studied in 4 subjects, each of whom had biliary T-tube drainage following cholecystectomy. The biliary excretion of tritium ranged from 3.7 to 27.5%, whereas the excretion in the urine was between 45.4 and 86.1%. The bile contained mostly estriol-3 sulfate-16 glucosiduronate (E3-3S-16G) and rather small amounts of E3-16G. The converse was true for the urine. No estriol-3 glucosiduronate (E3-3G) was identified in the urine, the maximum estimated amount being 0.5%. The detection of significant amounts of tritium in the bile is in disagreement with another report (Sandberg, A. A., and W. R. Slaunwhite, Jr., J Clin Invest 44: 694, 1965). When considered in conjunction with previous investigations, the results of this study strongly suggest that in intact subjects E3-3G is derived mainly, if not exclusively, from biliary E3-3S-16G and E3-16G.