Yazumi Shujiro, Chiba Tsutomu
Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
J Gastroenterol. 2005 Sep;40(9):861-5. doi: 10.1007/s00535-005-1698-5.
Right-lobe living donor liver transplantation (RL-LDLT) has become an acceptable procedure for adult patients with end-stage liver disease in this decade. However, biliary complications in RL-LDLT remain a serious problem: the incidence of anastomotic biliary leakage and stricture after RL-LDLT is reported to be 4.7%-18.2% and 8.3%-31.7%, respectively. The incidence varies according to the type of biliary reconstructions between Roux-en-Y hepaticojejunostomy and duct-to-duct biliary reconstruction. The anatomical biliary diversity of a right-lobe graft makes it difficult to reconstruct the biliary system. Indeed, most biliary strictures in patients with duct-to-duct reconstruction develop in multibranched fashion. In this regard, endoscopic biliary stenting appears to be efficacious for treating multibranched biliary strictures because multiple stenting permits the drainage of each segmental branch of the stricture. In this review, we describe various aspects of biliary complications occurring in RL-LDLT and their treatment.
在这十年间，右半肝活体供肝肝移植（RL-LDLT）已成为终末期肝病成年患者可接受的手术方式。然而，RL-LDLT中的胆道并发症仍然是一个严重问题：据报道，RL-LDLT后吻合口胆漏和狭窄的发生率分别为4.7%-18.2%和8.3%-31.7%。发生率因胆肠吻合方式（Roux-en-Y肝空肠吻合术和胆管对胆管吻合术）的不同而有所差异。右半肝移植物的解剖学胆道多样性使得胆道系统重建变得困难。实际上，胆管对胆管重建患者的大多数胆道狭窄以多分支形式出现。在这方面，内镜下胆道支架置入术似乎对治疗多分支胆道狭窄有效，因为多个支架可使狭窄的每个节段分支得到引流。在本综述中，我们描述了RL-LDLT中发生的胆道并发症的各个方面及其治疗方法。
