小儿活体肝移植中胆肠重建：胆管对胆管吻合或 Roux-en-Y 肝肠吻合术。

Biliary reconstruction in pediatric live donor liver transplantation: duct-to-duct or Roux-en-Y hepaticojejunostomy.

机构信息

Division of Surgery, National Center for Child Health and Development, Setagaya-Ku, Tokyo 157-8535, Japan.

出版信息

J Pediatr Surg. 2010 Aug;45(8):1668-75. doi: 10.1016/j.jpedsurg.2010.03.010.

DOI:10.1016/j.jpedsurg.2010.03.010

PMID:20713218

Abstract

BACKGROUND

Duct-to-duct biliary reconstruction (DD) is currently a standard procedure in adult live donor liver transplantation (LDLT). Its pediatric feasibility, however, has rarely been reported. The goal of this study is to assess the incidence and treatment of biliary complication after pediatric LDLT with DD or Roux-en-Y hepaticojejunostomy (RY).

METHOD

Sixty children received LDLT between November 2005 and June 2008, and their database was reviewed.

RESULTS

Biliary reconstruction was achieved with DD in 14 patients and with RY in 46 patients with mean follow-up period of 26.0 and 22.3 months, respectively. The incidence of biliary leakage in the DD and RY groups was 7.1% and 8.7%, respectively, and that of stricture was 28.6% and 10.9%, respectively; but the differences were not statistically significant. Biliary stricture in the DD group tended to require revision surgery with RY and longer treatment with percutaneous transhepatic cholangiodrainage compared with that in the RY group.

CONCLUSION

Theoretical advantages of DD over RY were not confirmed in this study. Duct-to-duct biliary reconstruction tended to encounter more biliary complications, especially stricture, with more difficulty in treating it than RY. Roux-en-Y hepaticojejunostomy seems preferable to DD in the setting of pediatric LDLT, but DD must be considered when making new Roux-en-Y limb seems impossible or troublesome owing to abdominal dense adhesion or short bowel syndrome.

摘要

背景

胆管对胆管重建（DD）目前是成人活体肝移植（LDLT）的标准程序。然而，其在儿科的可行性很少有报道。本研究旨在评估 DD 或 Roux-en-Y 胆肠吻合术（RY）在小儿 LDLT 后胆管并发症的发生率和治疗方法。

方法

2005 年 11 月至 2008 年 6 月期间，60 名儿童接受了 LDLT，对其数据库进行了回顾性分析。

结果

14 例采用 DD 进行胆管重建，46 例采用 RY 进行胆管重建，平均随访时间分别为 26.0 个月和 22.3 个月。DD 组和 RY 组的胆漏发生率分别为 7.1%和 8.7%，狭窄发生率分别为 28.6%和 10.9%，但差异无统计学意义。DD 组胆管狭窄倾向于需要行 RY 修正手术，且需要经皮经肝胆管引流治疗的时间也比 RY 组长。