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肝移植术中新型胆道重建技术

Novel Biliary Reconstruction Techniques During Liver Transplantation.

作者信息

Carmody Ian C, Romano John, Bohorquez Humberto, Bugeaud Emily, Bruce David S, Cohen Ari J, Seal John, Reichman Trevor W, Loss George E

机构信息

Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

出版信息

Ochsner J. 2017 Spring;17(1):42-45.

Abstract

BACKGROUND

Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant.

METHODS

A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years.

RESULTS

No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications.

CONCLUSION

Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.

摘要

背景

肝移植术后胆道并发症仍然是一个重大问题。在胆道吻合术中,有几种手术方式可用于处理供体和受体胆管之间明显的尺寸不匹配情况。我们在尸体肝移植中比较了胆管转位术和受体胆管成形术。

方法

2005年1月1日至2013年12月31日共进行了33例重建手术。在胆管转位组(n = 23)中,5例重建手术使用了内部支架(5或8法式小儿喂养管),18例未使用。在10例胆管成形术中,2例使用了支架。所有患者均接受标准免疫抑制治疗和熊去氧胆酸治疗。随访时间为2个月至5年。

结果

胆管转位组中没有患者需要再次手术;1例患者因反复出现不明原因的白细胞增多症而取出了内部支架,2例患者因出现狭窄迹象需要进行内镜逆行胆管造影和支架置入术。胆管成形术组发生了3例吻合口漏,该组有2例患者因胆道并发症需要再次手术。

结论

我们的结果表明,胆管重建可采用胆管转位术或胆管成形术。当供体和受体胆管直径存在明显不匹配时,这些技术特别有用。

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