Endoscopic management of biliary complications after adult living donor liver transplantation
Endoscopic management of biliary complications after adult living donor liver transplantation
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DOI：
10.1111/j.1572-0241.2004.30775.x
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发表时间：
2004-07-01
影响因子：
9.8
通讯作者：
Ginsberg, GG
中科院分区：
文献类型：
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作者：
Shah, JN;Ahmad, NA;Ginsberg, GG
结论：成人尸体肝移植（CLT）中的胆道并发症及其治疗已被充分描述。然而，活体肝移植（LDLT）的胆道并发症及其处理还没有很好的特点。我们评估了内镜逆行胰胆管造影术（ERCP）在诊断和治疗胆系并发症的LDLT.METHODS：我们进行了回顾性队列分析所有LDLT收件人与管-管闭塞（n = 15）的作用。具体数据包括ERCP转诊、诊断和治疗。比较了260 CLT收件人coherent.RESULTS：更大的百分比LDLT收件人接受ERCP（73%）相比，CLT收件人（25%; P = 0.001）。LDLT接受者经ERCP诊断的胆道并发症包括胆漏和狭窄，比CLT接受者更常见（胆漏：53% vs 12%; p = 0.001;狭窄：27% vs 5%; p = 0.01）。大多数泄漏发生在T型管部位（LDLT：87%; CLT 65%）。两组中，渗漏的诊断和治疗平均需要2次ERCP手术。LDLT和CLT接受者中分别有100%和84%的胆漏经内镜成功治疗（p 0.56）。大部分胆管狭窄为吻合性狭窄（LDLT：100%; CLT：64%）。LDLT组和CLT组分别用中位数为1.5和2次的ERCP手术诊断和治疗了颅内出血。内镜治疗的持续时间中位数为10周和14周，LDLT和CLT组的成功率分别为75%和62%（p = 1.0），分别为CONCLUSIONS：LDLT与CLT相比，胆道并发症增加。ERCP有助于诊断，可成功治疗大多数LDLT相关的胆道并发症，应在进行更具侵入性的干预之前尝试。
OBJECTIVES: Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT.METHODS: We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15). Specific data included referral for ERCP, diagnosis, and therapy. Comparisons were made to a 260 CLT recipient cohort.RESULTS: Greater percentage of LDLT recipients underwent ERCP (73%) compared to CLT recipients (25%; p = 0.001). Biliary complications diagnosed by ERCP in LDLT recipients consisted of bile leaks and strictures, and were more frequent than in CLT recipients (leaks: 53% vs 12%; p = 0.001; strictures: 27% vs 5%; p = 0.01). Most leaks occurred at T-tube sites (LDLT: 87%; CLT 65%). Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups. Bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively (p 0.56). Most biliary strictures were anastomotic (LDLT: 100%; CLT: 64%). Strictures were diagnosed and treated with a median of 1.5 and 2 ERCP procedures in the LDLT and CLT groups, respectively. The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% (p = 1.0) in LDLT and CLT groups, respectively.CONCLUSIONS: LDLT is associated with increased biliary complications as compared to CLT. ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions.