Incidence and management of biliary complications after adult-to-adult living donor liver transplantation
Incidence and management of biliary complications after adult-to-adult living donor liver transplantation
复制标题
DOI：
10.1111/j.1399-0012.2009.01124.x
复制
发表时间：
2010-07-01
影响因子：
2.1
通讯作者：
Makuuchi, Masatoshi
中科院分区：
文献类型：
--
作者：
Kyoden, Yusuke;Tamura, Sumihito;Makuuchi, Masatoshi
背景：大型成人活体供肝移植中胆道并发症的详细报道很少。患者和方法：对310例成人活体肝移植患者的胆道并发症、治疗方法和结果进行了回顾分析。223例(72.0%)行胆管间吻合术。观察期间(中位43个月)发生胆道并发症111例(36%)，胆漏53例(17%)，胆管狭窄70例(23%)，胆漏继发狭窄12例(4%)。266例(86%)患者在移植时放置了胆道吻合支架管。对各种临床因素的单变量分析显示，胆管间吻合术是胆道并发症的唯一显著危险因素(p=0.009)。有胆道并发症者的3年和5年生存率分别为88%和85%，无胆道并发症者分别为85%和83%(p=0.59)。结论：胆道并发症是LDLT术后并发症的主要原因。胆管间吻合术有较高的胆管狭窄风险。然而，如果有适当的管理，对总体存活率几乎没有影响。
Background:There are few detailed reports of biliary complications in a large adult living donor liver transplantation (LDLT) series.Patient and methods:Biliary complications, treatment modalities, and outcomes in these patients were retrospectively analyzed in 310 adult LDLT.Results:One patient underwent retransplantation. Duct-to-duct anastomosis was primarily performed in 223 patients (72%). During the observation period (median 43 months), biliary complications were observed in 111 patients (36%); 53 patients (17%) had bile leakage, 70 patients (23%) had bile duct stenosis, and 12 patients (4%) had bile leakage followed by stenosis. A biliary anastomotic stent tube was placed in 266 patients (86%) at the time of transplantation. Univariate analysis of various clinical factors revealed duct-to-duct anastomosis as the single significant risk factor (p = 0.009) for biliary complications. The three-yr and five-yr overall patient survival rates were 88% and 85% in those with biliary complications, and 85% and 83%, respectively, in those without biliary complications (p = 0.59).Conclusion:Biliary complications are a major cause of morbidity following LDLT. Duct-to-duct anastomosis carried a higher risk for bile duct stenosis. With appropriate management, however, there was little influence on overall survival.