Yan L, Li B, Zeng Y, Wen T, Zhao J, Wang W, Yang J, Xu M, Ma Y, Chen Z, Liu J, Wu H
Liver Transplantation Division, Department of Surgery, West China Hospital, Sichuan University Medical School, Chengdu 61004, China.
Transplant Proc. 2007 Jun;39(5):1513-6. doi: 10.1016/j.transproceed.2007.01.091.
High rates of biliary complications continue to be a major concern associated with living donor liver transplantation (LDLT). In this article, we report our experience of applying a microsurgical technique to biliary reconstruction in LDLT.
From January 2001 to December 2005, 32 patients underwent LDLTs (8 children and 24 adults). Biliary reconstruction for 43 hepatic duct orifices in the 32 donor grafts 21 duct-to-duct anastomoses, and 22 cholangiojejunostomies. Nine cholangiojejunostomies in 4 donors used a microsurgical technique under an operative microscope.
Biliary complications weren't observed among the cases of cholangiojejunostomy using a microsurgical technique. An anastomotic biliary leakage was found in a recipient with cholangiojejunostomy performed using a surgical loupe and a biliary stricture in another recipient who underwent duct-to-duct anastomoses using a surgical loupe.
Introduction of a microsurgical technique for biliary reconstruction in LDLT, especially using an operating microscope in the setting of hepatico-jejunostomy for small hepatic duct (< or =2 mm in diameter), showed good results. We believe that using the operative microscope for biliary reconstruction could reduce the incidence of biliary complications associated with LDLT.
胆道并发症的高发生率仍然是活体肝移植（LDLT）相关的一个主要问题。在本文中，我们报告了我们将显微外科技术应用于LDLT胆道重建的经验。
2001年1月至2005年12月，32例患者接受了LDLT（8例儿童和24例成人）。对32个供体移植物中的43个肝管开口进行胆道重建，其中21例为胆管对胆管吻合，22例为胆管空肠吻合术。4例供体中的9例胆管空肠吻合术在手术显微镜下采用显微外科技术。
采用显微外科技术的胆管空肠吻合病例未观察到胆道并发症。在1例使用手术放大镜进行胆管空肠吻合的受者中发现吻合口胆漏，在另1例使用手术放大镜进行胆管对胆管吻合的受者中发现胆管狭窄。
在LDLT中引入显微外科技术进行胆道重建，尤其是在直径小于或等于2mm的小肝管肝空肠吻合术中使用手术显微镜，显示出良好的效果。我们认为，使用手术显微镜进行胆道重建可以降低与LDLT相关的胆道并发症的发生率。
