Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin Transplant. 2020 Jun;34(6):e13850. doi: 10.1111/ctr.13850. Epub 2020 Mar 25.
The aim of this study was to clarify the impact of middle hepatic artery reconstruction on the outcomes of duct-to-duct biliary anastomosis after living donor liver transplantation (LDLT) using the left lobe.
Among 258 patients who underwent LDLT using the left lobe, 216 patients who underwent hepatic artery reconstruction and one hepatic duct reconstruction with duct-to-duct interrupted anastomosis were divided into three groups: Group A (n = 123), one arterial stump with left hepatic artery reconstruction; Group B (n = 32), two arterial stumps with only left hepatic artery reconstruction; and Group C (n = 61), two arterial stumps with reconstruction of the left and middle hepatic arteries. The outcomes after LDLT were compared among the three groups.
No hepatic artery complications occurred. Group B had a significantly greater incidence of anastomotic biliary stricture than Group C. A multivariate analysis with Cox regression revealed that being in Group B was the only significant independent risk factor for postoperative anastomotic biliary stricture after LDLT.
Middle and left hepatic artery reconstruction is safe in LDLT and may prevent biliary stricture caused by dual hepatic artery reconstruction when the graft has left and middle hepatic artery stumps.
本研究旨在阐明在活体肝移植（LDLT）中使用左叶进行胆管对胆管端端吻合术后，肝中动脉重建对其结果的影响。
在 258 例行 LDLT 采用左叶的患者中，216 例行肝动脉重建和 1 例行肝管重建采用胆管对胆管间断吻合术的患者分为三组：A 组（n=123），行左肝动脉重建的单个动脉残端；B 组（n=32），仅行左肝动脉重建的两个动脉残端；和 C 组（n=61），行左、中肝动脉重建的两个动脉残端。比较三组 LDLT 后的结果。
无肝动脉并发症发生。B 组吻合口胆管狭窄的发生率明显高于 C 组。多变量 Cox 回归分析显示，B 组是 LDLT 后术后吻合口胆管狭窄的唯一显著独立危险因素。
在 LDLT 中，中肝动脉和左肝动脉重建是安全的，当供体有左肝和中肝动脉残端时，可能会预防因双重肝动脉重建引起的胆管狭窄。
