Suehiro Taketoshi, Ninomiya Mizuki, Shiotani Satoko, Hiroshige Syoji, Harada Noboru, Ryosuke Minagawa, Soejima Yuji, Shimada Mitsuo, Sugimachi Keizo
Department of Surgery and Medical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Liver Transpl. 2002 May;8(5):495-9. doi: 10.1053/jlts.2002.32986.
Biliary complications, including bile leak, biliary stricture, and cholangitis, are seen in 15% to 29% of all cases after living related liver transplantation. We investigate risk factors and discuss the management of biliary complications after living related liver transplantation in adults using left-lobe grafts. We studied 37 adult patients who underwent living related liver transplantation using left-lobe grafts. Perioperative variables were evaluated as risk factors for biliary strictures. The overall incidence of biliary complications was 43.2% (16 of 37 patients). Anastomotic strictures occurred in 8 patients, whereas bile leaks and cholangitis occurred in 9 and 8 patients, respectively. Anastomotic stricture was strongly related to a partial artery reconstruction (P <.02) and cholangitis (P <.01). Anastomotic biliary stricture was not associated with bile leak, acute cellular rejection, or infection. Our results suggest that an important risk factor for biliary anastomotic biliary strictures is a partial artery reconstruction. To minimize the risk for biliary anastomotic strictures, we will reconstruct both the middle and left hepatic artery.
在亲属活体肝移植后的所有病例中，胆道并发症（包括胆漏、胆管狭窄和胆管炎）的发生率为15%至29%。我们对使用左叶移植物的成人亲属活体肝移植术后胆道并发症的危险因素进行调查并讨论其处理方法。我们研究了37例接受左叶移植物亲属活体肝移植的成年患者。对围手术期变量进行评估，作为胆管狭窄的危险因素。胆道并发症的总发生率为43.2%（37例患者中的16例）。8例患者发生吻合口狭窄，9例和8例患者分别发生胆漏和胆管炎。吻合口狭窄与部分动脉重建密切相关（P <.02）和胆管炎（P <.01）。吻合口胆道狭窄与胆漏、急性细胞排斥反应或感染无关。我们的结果表明，部分动脉重建是胆道吻合口狭窄的一个重要危险因素。为了将胆道吻合口狭窄的风险降至最低，我们将重建肝中动脉和肝左动脉。
