Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transpl. 2013 Feb;19(2):207-14. doi: 10.1002/lt.23582.
We describe our early and long-term experience with routine biliary reconstruction via a microsurgical technique in living donor liver transplantation (LDLT). One hundred seventy-seven grafts (including 3 dual grafts) were primarily transplanted into 174 recipients. The minimum follow-up was 44 months. Biliary reconstructions were based on biliary anatomical variations in graft and recipient ducts. The recipient demographics, graft characteristics, types of biliary reconstruction, biliary complications (BCs), and outcomes were evaluated. There were 130 right lobe grafts and 47 left lobe grafts. There were single ducts in 71.8%, 2 ducts in 26.0%, and 3 ducts in 2.3% of the grafts. The complications were not significantly related to the size and number of ducts, the discrepancy between recipient and donor ducts, the recipient age, the ischemia time, or the type of graft. The overall BC rate was 9.6%. The majority of the complications occurred within the first year, and only 1 patient developed a stricture at 20 months. No new complications were noted after 2 years. When the learning-curve phase of the first 15 cases was excluded, the overall BC rate was 6.79%, and the rate of complications requiring interventions was 2.5%. In conclusion, the routine use of microsurgical biliary reconstruction decreases the number of early and long-term anastomotic BCs in LDLT.
我们描述了我们在活体肝移植 (LDLT) 中通过显微外科技术进行常规胆道重建的早期和长期经验。177 个移植物（包括 3 个双移植物）被首次移植到 174 个受者中。最小随访时间为 44 个月。胆道重建基于移植物和受者胆管的胆道解剖变异。评估了受者人口统计学特征、移植物特征、胆道重建类型、胆道并发症 (BC) 和结局。有 130 个右叶移植物和 47 个左叶移植物。移植物中有 71.8%为单胆管，26.0%为双胆管，2.3%为三胆管。并发症与胆管数量和大小、受者和供者胆管之间的差异、受者年龄、缺血时间或移植物类型无关。总的 BC 发生率为 9.6%。大多数并发症发生在移植后 1 年内，仅 1 例患者在 20 个月时发生狭窄。2 年后未发现新的并发症。当排除前 15 例的学习曲线阶段时，总的 BC 发生率为 6.79%，需要干预的并发症发生率为 2.5%。总之，常规使用显微胆道重建可减少 LDLT 中早期和长期吻合口 BC 的数量。
