Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications
Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications
复制标题
使用右肝叶的活体相关肝移植中的胆道吻合术：技术和并发症
DOI：
10.1053/jlts.2000.18706
复制
发表时间：
2000
影响因子：
4.6
通讯作者：
C. Broelsch
中科院分区：
文献类型：
--
作者：
G. Testa;M. Malágo;C. Valentín‐Gamazo;G. Lindell;C. Broelsch
自从引入使用肝右叶的成人间活体肝移植以来，胆道问题已经导致了导致术后发病率的并发症列表。我们报告了1998年8月至2000年1月在我们机构进行的前30例活体肝移植的经验。患者为21名男性和9名女性，平均年龄45 ± 16岁。平均受体重量为65.1 ± 17.9 kg，平均移植物重量为877 ± 146 g，平均移植物-受体重量比为1.5 ± 0.6。患者和移植物存活率分别为83.3%和80%。胆道吻合术是端端肝管胆总管吻合术和T型引流管或肝管空肠吻合术。平均随访时间为217.4 ± 149.8天。总体并发症发生率为26.6%（8/30例手术），与吻合术类型和胆管数量直接相关。所有病例均需要手术翻修。胆道并发症不是移植物丢失的主要原因。使用右叶的成人活体肝移植是一种成功的手术，移植物和患者存活率与尸体全器官移植相似。术后并发症主要由胆漏引起，与胆管数量和吻合方式直接相关。随着经验的增加，我们在肝门板上更好地定义了我们的横断平面，目标是仅获得1根胆管用于吻合。我们还改进了我们的实质横切技术，从而降低了切割表面区域泄漏的发生率。
Since the introduction of adult‐to‐adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 ± 16 years. Mean recipient weight was 65.1 ± 17.9 kg, mean graft weight was 877 ± 146 g, and the mean graft‐recipient weight ratio was 1.5 ± 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end‐to‐end hepaticocholedochostomy with a T‐drain or hepaticojejunostomy. Mean follow‐up was 217.4 ± 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full‐organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut‐surface area.
影响因子：
9
作者：
Fong, YM;Sun, RL;Blumgart, LH
通讯作者：
Blumgart, LH