Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Surg Endosc. 2023 Jun;37(6):4974-4981. doi: 10.1007/s00464-023-10066-1. Epub 2023 Apr 20.
Accurate division of bile duct during laparoscopic donor hepatectomy in living donor liver transplantation is essential. We here present a novel approach to achieve cholangiography via the bile duct stump of segment IV (B4 stump) during laparoscopic donor hepatectomy in adult-to-pediatric living donor liver transplantation.
Donors who underwent laparoscopic left lateral sectionectomy (LLLS) from January 2022 to April 2022 in our liver transplant center were retrospectively analyzed. A total of 32 donors were eventually enrolled into this study. Cholangiography via the B4 stump was performed in 11 donors (B4 group) while indocyanine green (ICG) fluorescence guiding was performed in 21 donors (ICG group). Perioperative data were collected and compared between groups.
Cholangiography by catheterizing the B4 stump was successfully performed in all 11 donors in the B4 group. The mean time of this procedure was 12.82 ± 9.11 min. Compared to the ICG group, it was more likely to acquire single bile duct orifice on graft in the B4 group (B4: 10/11, 90.91% vs ICG: 9/21, 42.86%) and it was significantly different (p = 0.030). The donors' complications (Clavien-Dindo grade III-IV) were not significantly different. There was one donor developed intraperitoneal effusion in B4 group, while two donors (one bile leakage and one biliary stricture) developed biliary tract related complications in the ICG group. A Roux-en-Y was performed to solve the biliary stricture in the ICG group. The recipients' outcomes were not significantly different between groups.
Cholangiography via the B4 stump catheterization is feasible and safe in identifying the bifurcation of bile duct during LLLS.
腹腔镜供体肝切除术中准确分离胆管对于活体肝移植至关重要。我们在此介绍一种新的方法，即在成人至儿童活体肝移植的腹腔镜供体肝切除术中通过第四段胆管残端（B4 残端）进行胆管造影。
回顾性分析 2022 年 1 月至 2022 年 4 月在我院肝移植中心行腹腔镜左外叶切除术（LLLS）的供者。最终共有 32 名供者入组本研究。11 名供者（B4 组）行 B4 残端胆管造影，21 名供者（ICG 组）行吲哚菁绿（ICG）荧光引导。收集并比较两组的围手术期数据。
B4 组 11 名供者均成功完成 B4 残端胆管造影。该操作的平均时间为 12.82±9.11 分钟。与 ICG 组相比，B4 组更有可能在供肝上获得单个胆管口（B4：10/11，90.91% vs ICG：9/21，42.86%），差异有统计学意义（p=0.030）。供者并发症（Clavien-Dindo 分级 III-IV）无显著差异。B4 组有 1 名供者发生腹腔积液，ICG 组有 2 名供者发生胆管相关并发症（1 例胆漏，1 例胆管狭窄）。ICG 组的胆管狭窄患者行 Roux-en-Y 手术治疗。两组受者的结局无显著差异。
B4 残端胆管造影在 LLLS 中识别胆管分叉是可行和安全的。
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