Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transpl. 2009 Dec;15(12):1766-75. doi: 10.1002/lt.21947.
Biliary reconstruction using a microsurgical technique in living donor liver transplantation was routinely performed on 88 grafts primarily transplanted into 85 patients. All procedures were performed under a microscope by a single microsurgeon. Except for biliary atresia and Alagille syndrome, duct-to-duct reconstruction was performed. Stents were not used. The outcomes with microsurgical biliary reconstruction (MB) were compared with the outcomes of a cohort of 86 grafts in 85 patients that underwent conventional biliary reconstruction (CB). The identification of complications included only up to 12 months of follow-up for each recipient in both groups. The average graft duct sizes were 2.8 mm for MB and 3.4 mm for CB. Most complications occurred in the first 15 cases with MB, and these cases were considered to constitute the learning curve phase. The MB complication rate was 46.7% in the first 15 cases, 20.0% in the next 15 cases, and 5.4% in the last 55 cases. When the learning curve phase was excluded, the overall complication rate over time with MB (8.9%) was significantly lower than that with CB (21.9%). CB increased the risk of biliary complications by 2.5 times (relative risk: 2.5; attributable risk: 128; odds ratio: 2.9). In conclusion, routine MB is a technical innovation that leads to decreased early anastomotic complications in living donor liver transplantation.
在活体肝移植中，我们采用显微外科技术进行胆道重建，共对 85 例患者的 88 个移植物进行了胆道重建。所有手术均由一位显微外科医生在显微镜下进行。除胆道闭锁和 Alagille 综合征外，我们均采用端端吻合的方法进行胆道重建，未使用支架。我们将采用显微外科胆道重建（MB）的结果与采用传统胆道重建（CB）的 86 个移植物在 85 例患者中的结果进行了比较。并发症的识别仅包括两组中每个受者的 12 个月随访期内的并发症。MB 组的平均胆管直径为 2.8mm，CB 组为 3.4mm。MB 组大多数并发症发生在最初的 15 例中，这些病例被认为构成了学习曲线阶段。在最初的 15 例中，MB 的并发症发生率为 46.7%，接下来的 15 例中为 20.0%，最后 55 例中为 5.4%。当排除学习曲线阶段时，MB 组在整个随访期间的总体并发症发生率（8.9%）明显低于 CB 组（21.9%）。CB 使胆道并发症的风险增加了 2.5 倍（相对风险：2.5；归因风险：128；比值比：2.9）。总之，常规采用 MB 是一种技术创新，可降低活体肝移植中吻合口早期并发症的发生。
