Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
Int J Surg. 2020 Oct;82S:138-144. doi: 10.1016/j.ijsu.2020.04.069. Epub 2020 May 5.
For a technically successful liver transplant (LT), secure bile duct anastomosis to prevent biliary complications (BC's) like biliary anastomotic stricture (BAS) and bile leak (BL) is mandatory. BC's after living donor liver transplantation (LDLT) are relatively more common compared to deceased donor LT (DDLT), particularly owing to surgical factors (small diameter, and/or multiple bile duct openings on the graft), and non-surgical factors (immunologic reactions). Adequate blood supply to the bile duct both in donor and recipient, meticulous anastomotic technique, mucosal eversion for better approximation thus avoiding lesser fibrosis, proper use of internal or external stent drainage, and tension-free anastomosis, may contribute to the decrease of BC's after LDLT. Further, if BC's are not dealt with in a timely manner, these could progressively lead to severe morbidities and even mortality. While the endoscopic approach is preferred initially to deal with biliary leaks or strictures, the more invasive percutaneous approach may be required in case of endoscopic failure. Dedicated and experienced endoscopists, and interventional radiologists are key members of the multidisciplinary team in a successful LDLT program. In this review, we have tried to summarize current concepts in surgical techniques of biliary reconstruction in LDLT, incidence and risk factors for BC's, and principles followed to try and reduce the incidence of the same.
对于技术上成功的肝移植（LT），必须确保胆管吻合以防止胆管并发症（BC），如胆管吻合口狭窄（BAS）和胆漏（BL）。与尸体供肝移植（DDLT）相比，活体供肝移植（LDLT）后 BC 更为常见，这主要是由于手术因素（供体胆管直径较小，和/或多个胆管开口）和非手术因素（免疫反应）。供体和受体胆管充足的血液供应、精细的吻合技术、黏膜外翻以更好地接近，从而避免较少的纤维化、适当使用内支架或外支架引流以及无张力吻合，可能有助于减少 LDLT 后的 BC。此外，如果不及时处理 BC，这些可能会逐渐导致严重的并发症，甚至死亡。虽然最初倾向于采用内镜方法来处理胆漏或狭窄，但如果内镜治疗失败，可能需要更具侵袭性的经皮方法。有专门知识和经验的内镜医生和介入放射科医生是 LDLT 成功方案多学科团队的关键成员。在这篇综述中，我们试图总结 LDLT 中胆管重建的手术技术、BC 的发生率和危险因素，以及为降低其发生率而遵循的原则。
