Biliary reconstruction in liver transplant patients with primary sclerosing cholangitis, duct-to-duct or Roux-en-Y?
Biliary reconstruction in liver transplant patients with primary sclerosing cholangitis, duct-to-duct or Roux-en-Y?
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DOI：
10.1111/ctr.12964
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发表时间：
2017-06-01
影响因子：
2.1
通讯作者：
Malekhosseini, Seyed Ali
中科院分区：
文献类型：
--
作者：
Shamsaeefar, Alireza;Shafiee, Mohammad;Malekhosseini, Seyed Ali
Roux-en-Y胆肠吻合术和D-D吻合术是肝移植的胆道重建方法。然而，对于哪种方法产生更好的结果存在争议。我们比较了D-D吻合术与Roux-en-Y肝空肠吻合术在设拉子器官移植中心接受肝移植的原发性硬化性胆管炎患者的疗效。资料：回顾1996 ~ 2015年405例原发性硬化性胆管炎（PSC）肝移植患者的病历。患者分为Roux-en-Y组和D-D组。比较两组患者的发病率、疾病复发率、移植物和患者生存率。结果：共有143例患者进行了D-D胆道重建，260例患者进行了Roux-en-Y袢。胆道并发症发生率在D-D组为4.2%，Roux-en-Y组为3.9% （P= 0.863）。D-D组和Roux-en-Y组的1、3和5年精算生存率分别为92%、85%和74%；分别为87%、83%和79% （P=.384）。相应的1、3、5年胆道并发症发生率分别为97%、95%、92%；分别为98%、97%、94% （P= 0.61）。结论：肝移植行胆道导管到胆道重建术是替代Roux-en-Y胆道重建术的较好选择。
Introduction: Roux-en-Y choledochojejunostomy and duct-to-duct (D-D) anastomosis are biliary reconstruction methods for liver transplantation. However, there is a controversy over which method produces better results. We have compared the outcome of D-D anastomosis vs. Roux-en-Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in Shiraz Organ Transplant Center.Materials: The medical records of 405 patients with primary sclerosing cholangitis (PSC) who had undergone liver transplant from 1996 to 2015 were reviewed. Patients were divided into two groups: Roux-en-Y group and D-D group. Morbidity, disease recurrence, and graft and patient survival rates were compared between the two groups.Results: Total of 143 patients underwent a D-D biliary reconstruction, and 260 patients had a Roux-en-Y loop. Biliary complication involved 4.2% of patients from the D-D group, and 3.9% from the Roux-en-Y group (P=.863). Actuarial 1-, 3-, and 5-year patient survival for D-D and Roux-en-Y group was 92%, 85%, and 74%; and 87%, 83%, and 79%, respectively (P=.384). The corresponding 1-, 3-, and 5-year probability of biliary complication was 97%, 95%, and 92%; and 98%, 97%, and 94%, respectively (P=.61).Conclusion: Duct-to-duct biliary reconstruction in liver transplantation for selected patients with PSC is a good alternative instead of Roux-en-Y biliary reconstruction.