Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
J Hepatobiliary Pancreat Sci. 2011 Mar;18(2):170-5. doi: 10.1007/s00534-010-0322-0.
BACKGROUND/PURPOSE: In spite of the great risk involved, the donor bile duct division procedure has not been thoroughly addressed in the literature. The purpose of this study is to show the appropriate approach to bile duct division in living donor hepatectomy.
Of 87 living donor liver surgeries, we performed bile duct division by marking the cutting point using a small vascular clip under ordinary cholangiography in the first 37 patients, while the current procedure was used in 50 patients by encircling the cutting point using a radiopaque marker filament under real-time C-arm cholangiography.
Regarding the procurement of the 51 right lobe grafts, the incidence of multiple bile ducts in the graft was significantly reduced by our novel procedure [20/28 (71%) vs. 7/23 (30%), P < 0.01, Fisher's test]. Overall, there were no biliary strictures after surgery in any of the donors, with a median follow-up period of 43 months (range 8-136).
Our procedure of bile duct division in living liver donor surgery enabled us to avoid the biliary stricture while cutting the bile duct of the donor with great accuracy.
背景/目的：尽管存在巨大的风险，但供体胆管分离术在文献中并未得到充分阐述。本研究旨在展示活体肝移植中胆管分离的合适方法。
在 87 例活体肝移植手术中，我们在前 37 例中通过普通胆管造影术使用小血管夹标记切割点来进行胆管分离，而在 50 例中通过实时 C 臂胆管造影术使用不透射线标记丝环绕切割点来进行胆管分离。
关于 51 例右叶供体的获取，我们的新方法显著降低了供体中多支胆管的发生率[20/28（71%）比 7/23（30%），P < 0.01，Fisher 检验]。总体而言，在任何供体中均未发生术后胆管狭窄，中位随访时间为 43 个月（8-136 个月）。
我们在活体肝移植手术中进行胆管分离的方法使我们能够在准确切割供体胆管的同时避免胆管狭窄。
