Park C-S, Jung B-H, Hwang S, Park Y-H, Kang S-H, Park G-C, Song G-W, Jung D-H, Ahn C-S, Kim K-H, Moon D-B, Ha T-Y, Lee S-G
Department of Surgery, Gangneung Asan Hospital, Gangneung, Gangwondo, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2014 Apr;46(3):678-81. doi: 10.1016/j.transproceed.2013.11.150.
This study compared the incidence of biliary complication (BC) in adult living donor liver transplant recipients who underwent right-lobe duct-to-duct anastomosis (DDA) with or without external biliary drainage (EBD) and intended to optimize EBD tube clamping.
This study consisted of a retrospective assessment of EBD effect and a prospective trial for EBD tube-clamping optimization. The retrospective study included the EBD group (n = 208) and the non-EBD group (n = 145). The prospective study included 60 patients with EBD.
In the retrospective study, single DDA was performed in 83.7% of the EBD group and 80.7% of the non-EBD group (P = .47). One-year overall incidence of BC was 14.4% in the EBD group and 16.8% in the non-EBD group (P = .48). The incidence of early anastomotic bile leakage was 1.0% in the EBD group and 4.8% in the non-EBD group (P = .036). In the prospective study, there was no difference in tube-clamping success rates between low- and high-output EBD groups. There was also no statistical difference between the success and failure groups in terms of graft duct size, liver function tests, and post-transplant days at tube clamping.
The size of our EBD tube was too small for the graft duct size, therefore its main role appeared to be early biliary decompression, which helped prevent bile leakage and also simplified the route of cholangiogram in detecting early BC. Hence, EBD is worthy of performing in selected patients with a high risk of anastomotic bile leak.
本研究比较了接受右叶胆管对胆管吻合术（DDA）且有或无外引流（EBD）的成人活体肝移植受者的胆道并发症（BC）发生率，并旨在优化EBD管夹闭。
本研究包括对EBD效果的回顾性评估和EBD管夹闭优化的前瞻性试验。回顾性研究包括EBD组（n = 208）和非EBD组（n = 145）。前瞻性研究包括60例EBD患者。
在回顾性研究中，EBD组83.7%和非EBD组80.7%进行了单纯DDA（P = 0.47）。EBD组BC的1年总发生率为14.4%，非EBD组为16.8%（P = 0.48）。EBD组早期吻合口胆漏发生率为1.0%，非EBD组为4.8%（P = 0.036）。在前瞻性研究中，低流量和高流量EBD组之间的管夹闭成功率没有差异。成功组和失败组在移植胆管大小、肝功能检查以及管夹闭时的移植后天数方面也没有统计学差异。
我们使用的EBD管对于移植胆管大小来说太小，因此其主要作用似乎是早期胆道减压，这有助于预防胆漏，并且在检测早期BC时也简化了胆管造影的途径。因此，EBD值得在吻合口胆漏高风险的特定患者中进行。
