Belli L, De Carlis L, Del Favero E, Rondinara G, Meroni A, Zani B, Rimoldi P, Cazzulani A, Brambilla G, Beati C
Department of Surgery, Ospedale Niguarda, Milan, Italy.
Transpl Int. 1991 Sep;4(3):161-5. doi: 10.1007/BF00335338.
Biliary complications are described as frequent causes of morbidity during the postoperative course of orthotopic liver transplantation (OLTx), even in recent papers. The authors report here on their experience with duct-to-duct anastomosis as their method of choice for biliary reconstruction in a consecutive series of 100 OLTx in adult patients. The original technique, as described by Starzl, was modified by the authors by performing a wide, longitudinal plasty of both the donor and recipient bile ducts, joined together with two polidioxanone running sutures, producing the effect of a side-to-side anastomosis. This technique was used in all procedures, even when a significant discrepancy was evident between the ducts (n = 10). Follow-up was completed in 100% of the patients for a period of 2-40 months (mean 13.1 months). Four major complications (4%) occurred including hepatic abscesses due to ascending cholangitis, T-tube dislocation, partial occlusion by a branch of the T-tube at the anastomotic site, and disruption of the bile duct after T-tube removal. In four other patients, transient abdominal pain followed removal of the stent. Neither strictures nor fistulas were observed. Choledochocholedochostomy on a T-tube stent represents, in our experience, the technique of choice for biliary reconstruction in OLTx. The procedure, as described in the present study, proved to be safe in preventing strictures and leakages and appears to be feasible in nearly 100% of all adult patients undergoing OLTx.
胆道并发症被认为是原位肝移植（OLTx）术后常见的发病原因，即使在最近的文献中也是如此。作者在此报告他们在100例连续成年患者原位肝移植中，采用胆管对胆管吻合术作为胆道重建首选方法的经验。作者对Starzl描述的原始技术进行了改良，对供体和受体胆管均进行了广泛的纵向整形，用两根聚二氧六环酮连续缝线将其连接在一起，形成侧侧吻合的效果。即使胆管之间存在明显差异（n = 10），该技术也应用于所有手术。100%的患者完成了2至40个月（平均13.1个月）的随访。发生了4例主要并发症（4%），包括上行性胆管炎导致的肝脓肿、T管脱位、T管分支在吻合部位部分阻塞以及T管拔除后胆管破裂。另外4例患者在拔除支架后出现短暂腹痛。未观察到狭窄或瘘管。根据我们的经验，T管支架胆管对胆管吻合术是原位肝移植胆道重建的首选技术。本研究中描述的手术在预防狭窄和渗漏方面被证明是安全的，并且在几乎所有接受原位肝移植的成年患者中似乎都是可行的。
