Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus, University College London Medical School, London, UK.
Transpl Int. 2012 Jan;25(1):64-8. doi: 10.1111/j.1432-2277.2011.01371.x. Epub 2011 Oct 22.
Roux-en-Y loop is considered the reconstruction method of choice in Orthotopic Liver Transplantation (OLT) for Primary Sclerosing Cholangitis (PSC). We have adopted an approach of duct-to-duct (D-D) reconstruction when recipient common bile duct is free of gross disease. Patients were divided into two groups: patients who underwent a Roux-en-Y choledochojejunostomy and patients who had a D-D anastomosis. Morbidity, mortality, disease recurrence and graft and patient survival were compared between the two groups and analyzed. Ninety-one patients had OLT for PSC. Sixty-three patients underwent a D-D biliary reconstruction, whereas 28 patients had a Roux-en-Y loop. Biliary leak complicated 8% from the D-D group, and 14% from the Roux-en-Y group (P = 0.08), whereas biliary strictures were identified in 10% vs. 7% patients from the D-D and Roux-en-Y group, respectively (P = 0.9). Actuarial 1, 3 and 10 year survival for D-D and Roux-en-Y group was (87%, 80% and 62%) and (82%, 73% and 73%), respectively (P = 0.7). The corresponding 1, 3 and 10 year graft survival was (72%, 58% and 42%) and (67%, 58% and 53%), respectively (P = 0.6). No difference was seen in disease recurrence rates. D-D biliary reconstruction in OLT for selected PSC patients remains our first option of reconstruction.
Roux-en-Y 袢被认为是原发性硬化性胆管炎（PSC）原位肝移植（OLT）的首选重建方法。当受体胆总管无明显病变时，我们采用胆管对胆管（D-D）重建。将患者分为两组：行 Roux-en-Y 胆肠吻合术的患者和行 D-D 吻合术的患者。比较两组患者的发病率、死亡率、疾病复发率、移植物和患者存活率，并进行分析。91 例患者因 PSC 行 OLT。63 例患者行 D-D 胆道重建，28 例患者行 Roux-en-Y 袢。D-D 组胆漏发生率为 8%，Roux-en-Y 组为 14%（P = 0.08），而 D-D 组和 Roux-en-Y 组胆管狭窄发生率分别为 10%和 7%（P = 0.9）。D-D 组和 Roux-en-Y 组 1、3 和 10 年的存活率分别为（87%、80%和 62%）和（82%、73%和 73%）（P = 0.7）。相应的 1、3 和 10 年移植物存活率分别为（72%、58%和 42%）和（67%、58%和 53%）（P = 0.6）。疾病复发率无差异。D-D 胆道重建仍是我们为选定的 PSC 患者行 OLT 的首选重建方法。
