Alsharabi A, Zieniewicz K, Michałowicz B, Patkowski W, Nyckowski P, Wróblewski T, Grzelak I, Paluszkiewicz R, Hevelke P, Remiszewski P, Cieślak B, Kornasiewicz O, Kotulski M, Skwarek A, Urban M, Sańko-Resmer J, Krawczyk M
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2007 Nov;39(9):2785-7. doi: 10.1016/j.transproceed.2007.09.017.
Biliary complications are known as a weak point of liver transplantation. Their occurrence can be related to the practice of draining the biliary anastomosis performed at the time of transplantation. At our institution, routine of anastomotic biliary drainage was abandoned in June 2004.
We sought to assess the occurrence and character of biliary complications following orthotopic liver transplantation in relation to the technique of anastomosis.
In two groups of transplantees: last 100 transplantations with biliary drainage (48 females and 52 males aged 17 to 64 years) and last 100 transplantations without drainage (52 females and 48 males aged 18 to 67 years). The results of treatment were compared, for biliary complications and their influence on further management. In both groups, the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In most cases (167) we performed a cholangiojejunal Roux-en-Y (CBD) end-to-end anastomosis, less commonly (33 cases) hepaticojejunal anastomoses.
In the first group, biliary complications (bile leak at the site of drainage, bile leak after T-tube removal, CBD strictures) requiring surgical or endoscopic intervention, occurred in 17% recipients. In one case, the biliary complication resulted in retransplantation. In the second group, biliary complications occurred in 11% patients. None of them caused organ loss.
Abandoning drainage of the biliary anastomosis has reduced the occurrence of early biliary complications after orthotopic liver transplantation.
胆道并发症是肝移植的一个薄弱环节。其发生可能与移植时进行的胆道吻合口引流操作有关。在我们机构，2004年6月放弃了吻合口胆道引流常规操作。
我们试图评估原位肝移植术后胆道并发症的发生情况及特点与吻合技术的关系。
两组受者：最后100例进行胆道引流的移植手术（48例女性和52例男性，年龄17至64岁）以及最后100例未进行引流的移植手术（52例女性和48例男性，年龄18至67岁）。比较两组治疗结果，包括胆道并发症及其对后续治疗的影响。两组中，移植的主要指征均为各种类型的肝硬化以及胆汁淤积性疾病。大多数情况下（167例）我们进行了胆管空肠Roux-en-Y（胆总管）端端吻合，较少见（33例）为肝管空肠吻合。
第一组中，需要手术或内镜干预的胆道并发症（引流部位胆汁漏、T管拔除后胆汁漏、胆总管狭窄）发生在17%的受者中。有1例因胆道并发症导致再次移植。第二组中，11%的患者发生了胆道并发症。均未导致器官丢失。
放弃胆道吻合口引流减少了原位肝移植术后早期胆道并发症的发生。
