Choledochocholedochostomy, a relatively safe procedure in orthotopic liver transplantation.
Choledochocholedochostomy, a relatively safe procedure in orthotopic liver transplantation.
复制标题
胆总管切开术，原位肝移植中相对安全的手术。
作者：
Krom Ra;Kingma Lm;H. Eb;H. Wesenhagen;Slooff Mj;Gips Ch
胆道吻合术一直被认为是肝移植的致命弱点，尤其是胆总管胆管吻合术被报道为命运不佳。然而，根据以往的实验经验，我们决定将胆总管吻合术作为原位肝移植首选的胆道吻合术。自1979年以来接受移植的31例患者中，有29例行胆总管吻合术。诊断出5例并发症(17%)，其中1例死亡。有两个并发症与T管的处理有关，需要简单的剖腹手术来解决腹膜内胆漏。其他三种并发症是主要的：1例胆管吻合口狭窄，需要改行肝管空肠吻合术，2例供体胆总管坏死。其中一名患者成功接受了再次移植，另一名患者死于脓毒症。两例患者的肝动脉吻合口均有血栓形成，而所有无胆道并发症的患者经血管造影或尸检证实肝动脉吻合口通畅。脓毒症的总发生率为26%，但只有4例(13%)与胆总管吻合术相关的脓毒症。供体胆管坏死与肝动脉吻合通畅之间的关系强调了一种无可挑剔的外科技术。在我们的31例患者中，胆道并发症的发生率很低，这表明胆总管吻合术在临床肝移植中是一种相对安全的胆道手术。
The biliary anastomosis has been considered the Achilles heel of liver transplantation, and especially the choledochocholedochostomy has been reported to be ill-fated. However, based on previous experimental experiences we decided to use the choledochocholedochostomy as the biliary anastomosis of preference in orthotopic liver transplantation. A choledochocholedochostomy has been performed in 29 of the 31 patients who have undergone transplantation since 1979. Five complications (17%) were diagnosed, of which one proved to be fatal. Two complications were related to the handling of the T-tube and required simple laparotomy to solve the intraperitoneal bile leakage. The other three complications were major: in one patient the choledochocholedochostomy was stenosed, requiring a conversion into a hepaticojejunostomy, while in two patients the donor common bile duct became necrotic. One of these patients underwent successful retransplantation, while the other died of sepsis. In both patients the hepatic artery anastomosis proved to be thrombosed, while in all patients without biliary complications the hepatic artery anastomosis was patent angiographically or at autopsy. The total incidence of sepsis was 26%, but in only four patients (13%) was sepsis related to the choledochocholedochostomy. The relationship between the necrosis of the donor bile duct and the patency of the hepatic artery anastomosis emphasizes an impeccable surgical technique. The low incidence of biliary complications in our 31 patients characterizes the choledochocholedochostomy as a relatively safe biliary procedure in clinical liver transplantation.