活体肝移植治疗原发性硬化性胆管炎中的胆管对胆管胆道重建：一例报告

Duct-to-duct Biliary Reconstruction in Living-donor Liver Transplantation for Primary Sclerosing Cholangitis: Report of a Case.

作者信息

Motomura T, Yoshizumi T, Wang H, Nagatsu A, Itoh S, Harada N, Harimoto N, Ikegami T, Uchiyama H, Soejima Y, Maehara Y

机构信息

Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Transplant Proc. 2017 Jun;49(5):1196-1198. doi: 10.1016/j.transproceed.2017.03.069.

DOI:10.1016/j.transproceed.2017.03.069

PMID:28583556

Abstract

Although Roux-en Y hepaticojejunostomy was previously recommended for the biliary reconstruction in liver transplantation for primary sclerosing cholangitis (PSC), some recent reports showed no difference in the graft survival between Roux-en Y and duct-to-duct anastomosis in deceased-donor liver transplantation. On the other hand, considering the risk of recurrence and the short length of the bile duct of the graft, duct-to-duct biliary anastomosis has never been reported in a patient undergoing living-donor liver transplantation (LDLT) for PSC. A 45 year-old male underwent LDLT using a left-lobe graft donated from his brother. Cholangiography showed no lesion in his common bile duct and duct-to-duct anastomosis was chosen for him. Fifteen months later, he suffered cholangitis due to PSC recurrence and endoscopic retrograde cholangiography was performed. The stents were inserted into his B2 and B3, and he remains well. Because of the ability to easily manage biliary complication, duct-to-duct biliary reconstruction may become the first choice in LDLT for PSC without common bile duct lesions.

摘要

尽管之前推荐采用Roux-en Y肝空肠吻合术进行原发性硬化性胆管炎（PSC）肝移植的胆道重建，但最近一些报告显示，在已故供体肝移植中，Roux-en Y吻合术与胆管对胆管吻合术在移植物存活方面并无差异。另一方面，考虑到复发风险和移植物胆管长度较短，尚未有关于PSC活体供体肝移植（LDLT）患者采用胆管对胆管胆道吻合术的报道。一名45岁男性接受了其兄弟捐献左叶移植物的LDLT。胆管造影显示其胆总管无病变，遂为其选择胆管对胆管吻合术。15个月后，他因PSC复发患上胆管炎，并接受了内镜逆行胆管造影。支架被置入其B2和B3胆管，他目前情况良好。由于能够轻松处理胆道并发症，对于无胆总管病变的PSC患者，胆管对胆管胆道重建可能成为LDLT的首选。