Biliary reconstruction in right lobe living-donor liver transplantation - Comparison of different techniques in 321 recipients
Biliary reconstruction in right lobe living-donor liver transplantation - Comparison of different techniques in 321 recipients
复制标题
DOI：
10.1097/01.sla.0000206419.65678.2e
复制
发表时间：
2006-04-01
影响因子：
9
通讯作者：
Tanaka, K
中科院分区：
文献类型：
--
作者：
Kasahara, M;Egawa, H;Tanaka, K
目标：评估右叶活体肝移植（LDLT）后行胆管-胆管吻合术或胆总管空肠Roux-en-Y吻合术重建的患者的胆道并发症发生率。胆道并发症仍然是肝移植后最严重的疾病之一。尚未进行大规模系列研究来比较LDLT中的2种技术。本研究进行了回顾性评估的方法之间的关系，胆道重建和并发症reported.Methods：1998年2月至2004年6月，321例患者接受右叶LDLT。胆总管空肠Roux-en-Y吻合术121例，胆总管胆管吻合术192例，胆总管空肠Roux-en-Y吻合术加胆管吻合术8例。结果：胆道并发症的发生率为24.0%。单因素分析显示肝动脉并发症、巨细胞病毒感染和血型不合是胆道并发症的重要危险因素。胆漏和狭窄的发生率分别为12.4%和8.3%，Roux-en-Y和4.7%和26.6%的胆管重建。导管到导管choledocholedochostomy表现出显着降低泄漏的发生率和狭窄的发生率较高，但是，74.5%的狭窄是管理与内镜treatment.Conclusions：作者发现在胆管狭窄率增加的导管到导管choledocholeclochostomy组。由于更好的生理性胆肠连续性、更少的渗漏发生率和更容易的内窥镜进入，胆管重建是右叶LDLT的可行技术。
Objective: To assess the incidence of biliary complications after right lobe living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy or Roux-en-Y choledochojejunostomy reconstruction. Summary Background Data: Biliary tract complications remain one of the most serious morbidities following liver transplantation. No large series has yet been carried out to compare the 2 techniques in LDLT. This study undertook a retrospective assessment of the relation between the method of biliary reconstruction used and the complications reported.Methods: Between February 1998 and June 2004, 321 patients received right lobe LDLT. Biliary reconstruction was achieved with Roux-en-Y choledochojejunostomy in 121 patients, duct-to-duct choledochocholedochostomy in 192 patients, and combined Roux-en-Y and duct-to-duct choledochocholedochostomy in 8 patients. The number of graft bile duct and anastomosis, mode of anastomosis, use of stent tube, and management of biliary complications were analyzed.Results: The overall incidence of biliary complications was 24.0%. Univariate analysis revealed that hepatic artery complications, cytomegalovirus infections, and blood type incompatibility were significant risk factors for biliary complications. The respective incidence of biliary leakage and stricture were 12.4% and 8.3% for Roux-en-Y, and 4.7% and 26.6% for duct-to-duct reconstruction. Duct-to-duct choledochocholedochostomy showed a significantly lower incidence of leakage and a higher incidence of stricture; however, 74.5% of the stricture was managed with endoscopic treatment.Conclusions: The authors found an increase in the biliary stricture rate in the duct-to-duct choledochocholeclochostomy group. Because of greater physiologic bilioenteric continuity, less incidence of leakage, and easy endoscopic access, duct-to-duct reconstruction represents a feasible technique in right lobe LDLT.