Janousek L, Maly S, Oliverius M, Kocik M, Kucera M, Fronek J
Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Transplant Proc. 2016 Dec;48(10):3312-3316. doi: 10.1016/j.transproceed.2016.09.039.
The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time.
Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments.
Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects.
Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents.
原位肝移植术后最常见的胆道并发症是胆漏、吻合口和肝内狭窄、结石以及壶腹功能障碍。这些并发症在高达10%至30%的肝移植受者中可能发生。胆漏发生在移植后的早期；狭窄形成通常随时间逐渐发展。
在我们的初步研究中，10例患者接受了移植：5例随机分为放置支架组，5例为对照组。我们研究了可吸收胆道支架的作用，目的是证明胆管对胆管胆道吻合的通畅性。这些支架由机器编织的聚二氧六环酮单丝制成。
我们的初步结果表明，使用可吸收内支架进行胆管对胆管胆道重建在所有5例患者中均具有良好的通畅性。在任何病例中，吻合口均无胆漏迹象，肝移植后也未观察到结石形成。胆道支架完全被吸收，无不良反应。
基于我们的初步经验和数据，我们得出结论，可生物降解支架可在临床实践中成功且安全地使用。需要进一步进行大型前瞻性随机研究来评估生物可吸收支架的疗效。
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