Decurtins M, Lachat M, Largiadèr F
Departement Chirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1990 Jun;57(1):83-6.
Complications of the biliary anatomosis are common after liver transplantation. Even with improved techniques the frequency of biliary complications is approximately ten percent. Main reason for this high morbidity rate is the unfavourable blood supply to the biliary tract. A variant of reconstructions has been described and recommended. The end-to-end-choledochocholedochostomy over a T tube turned out to be the preferred technique in most centers. In cases of different diameter of donor and recipient biliary tract, the side-to-side-choledochocholedochostomy provides a relayable alternative method. When the length of the bile duct doesn't allow direct anastomosis, the gallbladder-conduit may help to overcome this problem. The choledochojejunostomy with Roux-en-Y loop has become a frequently used biliary anastomosis, especially when the recipients bile duct is absent or otherwise destroyed. - Our own experience with fourteen liver transplantations shows biliary tract complications in three cases: a leakage and a stenosis of the anastomosis after choledochocholedochostomy were successfully transformed to a hepaticojejunostomy. In the third case, intrahepatic biliary stenosis were treated by percutaneous transhepatic dilatation.
肝移植术后胆道吻合口并发症很常见。即便技术有所改进，胆道并发症的发生率仍约为10%。如此高发病率的主要原因是胆道血供不佳。已有多种重建术式被描述和推荐。在大多数中心，经T管行胆总管端端吻合术被证明是首选技术。当供体和受体胆道直径不同时，胆总管侧侧吻合术提供了一种可靠的替代方法。当胆管长度不允许直接吻合时，胆囊导管可能有助于解决这一问题。带有Roux-en-Y袢的胆总管空肠吻合术已成为常用的胆道吻合方式，尤其是当受体胆管缺失或遭到破坏时。——我们自己14例肝移植的经验显示，有3例出现了胆道并发症：胆总管端端吻合术后的1例吻合口漏和1例狭窄成功转变为肝管空肠吻合术。第3例肝内胆管狭窄通过经皮经肝胆道扩张术进行了治疗。
