采用 Glissonian 鞘作为活体肝移植中预防胆管狭窄的一种替代方法。
Using Glissonian sheath as an alternative way to prevent biliary stricture in living-donor liver transplantation.
机构信息
Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
Asian J Surg. 2021 May;44(5):742-748. doi: 10.1016/j.asjsur.2020.12.032. Epub 2021 Jan 16.
BACKGROUND
/Objective: The aim of this study was to report a single-institution experience involving a Glissonian sheath-to-duct method for biliary reconstruction in living donor liver transplantation, focusing on the association between surgical techniques and biliary stricture rates.
METHODS
Three hundred and twenty adult right lobar living donor liver transplantation procedures were analyzed through a comparison of 200 Glissonian sheath-to-duct (GD) reconstructions and 120 duct-to-duct (DD) reconstructions in biliary anastomosis.
RESULTS
At a mean follow-up period of 60.8 months, the GD group had a significantly lower biliary stricture rate (13.5%, 27/200) than the DD group (26.7%, 32/120) (p = 0.003). In biliary anastomosis with single duct anastomosis, the incidence of biliary stricture was significantly greater for the DD group (17/79, 21.5%) than for the GD group (14/141, 9.9%) (p = 0.018).
CONCLUSION
This study has shown that GD anastomosis of the bile duct produced outstanding results with respect to the reduction of biliary stricture. The GD technique can therefore be suggested as an alternative method for biliary reconstruction in LDLT.
背景
/目的：本研究旨在报告单中心经验，涉及活体肝移植中 Glisson 鞘-胆管法胆管重建，重点关注手术技术与胆管狭窄发生率之间的关系。
方法
通过比较胆管吻合术中 200 例 Glisson 鞘-胆管（GD）重建和 120 例胆管-胆管（DD）重建，分析了 320 例成人右半肝活体供肝移植手术。
结果
在平均随访 60.8 个月后，GD 组的胆管狭窄率（13.5%，27/200）明显低于 DD 组（26.7%，32/120）（p=0.003）。在单胆管吻合术中，DD 组（17/79，21.5%）胆管狭窄的发生率明显高于 GD 组（14/141，9.9%）（p=0.018）。
结论
本研究表明，GD 胆管吻合术在减少胆管狭窄方面效果显著。因此，GD 技术可以作为 LDLT 中胆管重建的一种替代方法。
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