Benítez Cantero J M, Costán Rodero G, Montero Álvarez J L, Ayllón Terán M D, Naveas Polo C, Fraga Rivas E, Barrera Baena P, Poyato González A, López Cillero P, Luque Molina A, De la Mata Garcia M
Liver Transplantation Unit, Hospital Universitario Reina Sofia, Córdoba.
Transplant Proc. 2012 Sep;44(7):2098-9. doi: 10.1016/j.transproceed.2012.07.084.
Biliary complications are a frequent cause of morbidity, graft loss, and death after orthotopic liver transplantation (OLT). The choledochocholedochostomy anastomosis without a T-tube is controversial, as it has been related to more biliary complications.
The aims of this study were to determine the incidence and to identify the risk factors of post-OLT biliary complications after reconstruction with or without a T-tube.
Ninety-five consecutive adult patients with deceased donor liver transplantations (overall survival rate, 86.3%; mean follow-up, 22.2 months) were analyzed to determine the incidence and type of biliary complications in 2 groups: choledochocholedochostomy with (45 patients, Group I) or without a T-tube (50 patients, Group II). The incidence of biliary complications in Groups I and II was 40% (18/45) and 30% (15/50), respectively (P > .05). In Group I, 49% of the complications were directly related to the T-tube. Biliary anastomosis stricture was more frequent in Group II (28% vs 8.9% in Group I; P = .018). Endoscopic retrograde cholangiopancreatography (ERCP) was the most common therapeutic procedure for the resolution of biliary complications in both groups (Group I, 66.5%; Group II, 58.2%). Arterial thrombosis, high pretransplantation Model for End-Stage Liver Disease (MELD) score, and donor obesity were identified as risk factors for biliary complications after OLT.
OLT biliary reconstruction without a T-tube is not related to an increased risk of biliary complications, although stricutre of the anastomosis is more frequent in this group of patients. Donor obesity, arterial thrombosis, and high pretransplantation MELD score are associated with a higher incidence of biliary complications after OLT.
胆道并发症是原位肝移植（OLT）后发病、移植物丢失和死亡的常见原因。不放置T管的胆总管-胆总管吻合术存在争议，因为它与更多的胆道并发症相关。
本研究的目的是确定OLT后采用或不采用T管重建术后胆道并发症的发生率，并识别其危险因素。
对95例连续接受尸体供肝移植的成年患者（总生存率为86.3%；平均随访时间为22.2个月）进行分析，以确定两组患者胆道并发症的发生率和类型：放置T管的胆总管-胆总管吻合术组（45例患者，I组）和不放置T管的胆总管-胆总管吻合术组（50例患者，II组）。I组和II组胆道并发症的发生率分别为40%（18/45）和30%（15/50）（P>0.05）。在I组中，49%的并发症与T管直接相关。II组中胆管吻合口狭窄更为常见（28% vs I组的8.9%；P = 0.018）。内镜逆行胰胆管造影（ERCP）是两组中解决胆道并发症最常用的治疗方法（I组为66.5%；II组为58.2%）。动脉血栓形成、移植前终末期肝病模型（MELD）评分高和供体肥胖被确定为OLT后胆道并发症的危险因素。
OLT时不放置T管的胆道重建与胆道并发症风险增加无关，尽管该组患者吻合口狭窄更为常见。供体肥胖、动脉血栓形成和移植前MELD评分高与OLT后胆道并发症的较高发生率相关。
