Jafari Azin, Stoffels Burkhard, Kalff Jörg C, Manekeller Steffen
Department of Surgery, University Hospital Bonn, Bonn, Germany.
Ann Transplant. 2016 Jan 14;21:25-9. doi: 10.12659/aot.894692.
The biliary anastomosis remains to be the Achilles' heel of liver transplantation. The incidence of biliary complications (e.g., stenosis and leakage) is immanent and the optimal type of reconstruction is unclear. The aim of this study was to compare 2 different bile duct suture techniques regarding their benefits in the prevention of biliary complications.
From 1992 to 2012, the transplanted patients (n=394) of our center were analyzed retrospectively in terms of suture techniques and consecutive biliary complications. Secondary, possible risk factors (cold ischemic time, donor age, and preoperative liver function) were examined. An end-to-end choledocho-choledochostomy without T-tube was performed during orthotopic liver transplantation whenever possible. In group 1 (n=123) the biliary reconstruction was performed completely by continuous-suture technique. In group 2 (n=164) continuous-suture technique was also performed in posterior wall of the bile duct, but the anterior wall was closed by interrupted-suture technique.
The overall biliary complication rate was 19.6%. There were no significant differences in biliary complications between the groups. Analysis of risk factors showed no influence on the complication rate.
The argument for the interrupted-suture technique is a better overview and a lower risk to grab the posterior wall during the anastomotic realization. The threads of the anterior wall can be presented individually and then be knotted.
胆管吻合术仍是肝移植的薄弱环节。胆系并发症（如狭窄和渗漏）的发生率很高，且最佳重建方式尚不清楚。本研究旨在比较两种不同的胆管缝合技术在预防胆系并发症方面的益处。
回顾性分析1992年至2012年本中心394例肝移植患者的缝合技术及连续性胆系并发症情况。其次，研究可能的危险因素（冷缺血时间、供体年龄和术前肝功能）。原位肝移植时尽可能行无T管的端端胆管吻合术。第1组（n = 123）采用连续缝合技术完成胆管重建。第2组（n = 164）胆管后壁也采用连续缝合技术，但前壁采用间断缝合技术关闭。
胆系并发症总发生率为19.6%。两组胆系并发症无显著差异。危险因素分析显示对并发症发生率无影响。
间断缝合技术的优点是视野更好，吻合时抓住后壁的风险更低。前壁缝线可单独显露然后打结。
