Girard Edouard, Risse Olivier, Abba Julio, Medici Maud, Leroy Vincent, Chirica Mircea, Letoublon Christian
Service de Chirurgie Digestive et Générale, Hôpital Michallon, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, La Tronche, France.
Laboratory TIMC, CNRS, Grenoble-Alpes University, Grenoble, France.
Langenbecks Arch Surg. 2018 Jun;403(4):487-494. doi: 10.1007/s00423-018-1669-y. Epub 2018 Mar 24.
Internal biliary stenting (IBS) was reported to decrease biliary complications after liver transplantation (LT) but data in literature is scarce. The aim of the present study was to evaluate our experience with end-to-end choledoco-choledocostomy during liver transplantation with special focus on the influence of IBS on patient and biliary outcomes.
Between 2009 and 2013, 175 patients underwent deceased donor LT with end-to-end choledoco-choledocostomy and were included in the study. Supra-papillary silastic stent was inserted in 67 patients (38%) with small-size (< 5 mm) bile ducts (recipient or donor). Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for IBS removal, 6 months after LT. Operative outcomes and survival of patients who received internal stenting (IBS group) were compared with those of patients who did not (no-IBS group). Risk factors for biliary anastomotic complications were identified.
Ten patients died (6%) and 104 (59%) experienced postoperative complications. Five-year patient and graft survival rates were 77 and 74%, respectively. Biliary complications were recorded in 61 patients (35%) and were significantly decreased by IBS insertion (p = 0.0003). Anastomotic fistulas occurred in 23 patients (13%) and stenoses in 44 patients (25%). On multivariate analysis, high preoperative MELD scores (p = 0.02) and hepatic artery thrombosis (p < 0.0001) were predictors of fistula; absence of IBS was associated with both fistula (p = 0.014) and stricture (p = 0.003) formation.
IBS insertion during LT decreases anastomotic complication.
据报道，肝移植（LT）术后行胆道内支架置入术（IBS）可减少胆道并发症，但文献资料较少。本研究的目的是评估我们在肝移植术中进行端端胆管-胆管吻合术的经验，特别关注IBS对患者和胆道结局的影响。
2009年至2013年期间，175例患者接受了脑死亡供体肝移植术并进行了端端胆管-胆管吻合术，纳入本研究。67例（38%）胆管直径较小（<5mm）的患者（受体或供体）置入了乳头上方硅橡胶支架。肝移植术后6个月安排行内镜逆行胰胆管造影（ERCP）取出IBS。将接受内支架置入术的患者（IBS组）与未接受内支架置入术的患者（非IBS组）的手术结局和生存率进行比较。确定胆道吻合口并发症的危险因素。
10例患者死亡（6%），104例（59%）出现术后并发症。5年患者和移植物生存率分别为77%和74%。61例患者（35%）记录到胆道并发症，IBS置入可显著降低其发生率（p = 0.0003）。23例患者（13%）发生吻合口瘘，44例患者（25%）发生狭窄。多因素分析显示，术前终末期肝病模型（MELD）评分高（p = 0.02）和肝动脉血栓形成（p < 0.0001）是吻合口瘘的预测因素；未行IBS与吻合口瘘（p = 0.014）和狭窄（p = 0.003）的形成均相关。
肝移植术中置入IBS可降低吻合口并发症的发生率。
