胆道并发症包括单供体死亡：207 例成人对成人活体右肝移植的经验。
Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts.
机构信息
Department of Surgery, Ain-Shams University, Ain-Shams University, Cairo, Egypt.
出版信息
HPB (Oxford). 2010 Mar;12(2):109-14. doi: 10.1111/j.1477-2574.2009.00142.x.
BACKGROUND
After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%.
PATIENTS AND METHODS
Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 +/- 5.2 years.
RESULTS
Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 +/- 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 +/- 50 min with an estimated blood loss of 950 +/- 450 ml and returned cell-saver amount of 450 +/- 334 ml. Mean donor remnant liver volume was 33.5 +/- 3.2%. Mean intensive care unit (ICU) stay was 3 +/- 0.7 days and mean hospital stay was 14 +/- 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis.
CONCLUSION
Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.
背景
右叶捐献后，胆系并发症是主要的发病原因。右叶捐献后的死亡率估计不到 0.5%。
患者和方法
2001 年 11 月至 2008 年 12 月，共进行了 207 例成人对成人活体肝移植（ALDLT），使用右叶移植物。供者包括 173 名男性和 34 名女性，平均年龄为 28.4±5.2 岁。
结果
兄弟姐妹占 144 例（69.6%），而无关供者占 63 例（30.4%），平均体重指数（BMI）为 25.2±2.4。82 例（39.6%）和 125 例（60.3%）供者存在单支和多支右肝管（RHD）。手术时间平均为 360±50min，估计失血量为 950±450ml，回收细胞保存量为 450±334ml。供肝残余肝体积平均为 33.5±3.2%。平均重症监护病房（ICU）住院时间为 3±0.7 天，平均住院时间为 14±3.5 天。采用改良 Clavien 分级对所有供体胆系并发症进行分层。27 例（13.0%）发生了总胆系并发症。改良 Clavien 分级后，胆系并发症分级为 I 级（n=10）、II 级（n=2）、III 级（n=14）和 V 级（n=1）。I 级和 II 级（n=12）胆系并发症成功保守治疗。III 级病例分别采用超声引导抽吸（USGA）、内镜逆行胰胆管造影（ERCP）和手术治疗 10、2 和 2 例供者。1 例供者（0.4%）因胆漏伴腹膜炎失控而死亡，需要进行剖腹探查，随后进行 ERCP 并置入支架，但供者于第 43 天因持续败血症死亡。
结论
尽管大多数胆系并发症较轻且可保守治疗，但不可控制的胆漏是一种严重的发病率，应予以避免，因为它可能导致死亡。
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