Millis J M, Brems J J, Hiatt J R, Klein A S, Ashizawa T, Ramming K P, Quinones-Baldrich W J, Busuttil R W
Department of Surgery, UCLA School of Medicine 90024.
Arch Surg. 1988 Oct;123(10):1237-9. doi: 10.1001/archsurg.1988.01400340063011.
Forty-five patients with biliary atresia were accepted for orthotopic liver transplantation. Nine patients died awaiting transplantation, and 36 underwent transplantation. A portoenterostomy had been performed in 28 of these 36 patients, and its presence did not significantly affect the intraoperative blood loss (5.6 vs 4.1 blood volumes), the need for retransplantation (21% vs 12%), biliary complications (21% vs 12%), postoperative infections (36% vs 25%), or survival (82% vs 63%). These results indicate that early portoenterostomy is appropriate early therapy for biliary atresia; however, prompt referral to a liver transplant center for evaluation at the first sign of cholestasis is needed to attain optimal results for transplantation. Revisions of the portoenterostomy prior to transplantation did not improve the longevity of the procedure but did substantially increase complications and death after orthotopic liver transplantation.
45例胆道闭锁患者接受了原位肝移植。9例患者在等待移植过程中死亡，36例接受了移植。这36例患者中有28例曾行肝门空肠吻合术，其存在对术中失血量（5.6倍血容量对4.1倍血容量）、再次移植需求（21%对12%）、胆道并发症（21%对12%）、术后感染（36%对25%）或生存率（82%对63%）均无显著影响。这些结果表明，早期肝门空肠吻合术是胆道闭锁合适的早期治疗方法；然而，为了获得最佳的移植效果，在出现胆汁淤积的第一迹象时就需要迅速转诊至肝移植中心进行评估。移植前对肝门空肠吻合术进行修订并不能提高手术的长期效果，但确实会大幅增加原位肝移植后的并发症和死亡。
