Neuhaus P, Blumhardt G, Bechstein W O, Steffen R, Platz K P, Keck H
Department of Surgery, Free University of Berlin, Universitätsklinikum Rudolf Virchow, Germany.
Ann Surg. 1994 Apr;219(4):426-34. doi: 10.1097/00000658-199404000-00014.
The authors evaluated the complication rate and outcome of side-to-side common bile duct anastomosis after human orthotopic liver transplantation.
Early and late biliary tract complications after orthotopic liver transplantation remain a serious problem, leading to increased morbidity and mortality. Commonly performed techniques are the end-to-end choledochocholedochostomy and the choledochojejunostomy. Both techniques are known to coincide with a high incidence of leakage and stenosis of the bile duct anastomosis. The side-to-side bile duct anastomosis has been shown experimentally to be superior to the end-to-end anastomosis. The authors present the results of 316 human liver transplants, in which a side-to-side choledochocholedochostomy was performed.
Biliary tract complications of 370 transplants in 340 patients were evaluated. Three hundred patients received primary liver transplants with side-to-side anastomosis of donor and recipient common bile duct. Thirty-two patients with biliary tract pathology received a bilioenteric anastomosis, and in eight patients, side-to-side anastomosis was not performed for various reasons. Clinical and laboratory investigations were carried out at prospectively fixed time points. X-ray cholangiography was performed routinely in all patients on postoperative days (PODs) 5 and 42. In patients with suspected papillary stenosis, endoscopic retrograde cholangioscopy and papillotomy were performed.
One biliary leakage (0.3%) was observed within the early postoperative period (PODs 0 through 30) after liver transplantation. No stenosis of the common bile duct anastomosis was observed during this time. Late biliary stenosis occurred in two patients (0.6%). T tube-related complications were observed in 4 of 300 primary transplants (1.3%). Complications unrelated to the surgical technique, including papillary stenosis (5.7%) and ischemic-type biliary lesion (3.0%), which must be considered more serious in nature than complications of the anastomosis or T tube-related complications, were observed. Papillary stenosis led to frequent endoscopic interventions and retransplantations in 1.3%.
Side-to-side common bile duct anastomosis represents a safe technique of bile duct reconstruction and leads to a low technical complication rate after human orthotopic liver transplantation. Ischemic-type biliary lesion evoked by preservation injury, arterial ischemia, cholestasis, and cholangitis may represent a new entity of biliary complication, which markedly increases the morbidity after human liver transplantation. Therefore, this complication should be the subject of further research.
作者评估了人类原位肝移植术后胆总管侧侧吻合术的并发症发生率及预后情况。
原位肝移植术后早期和晚期胆道并发症仍然是一个严重问题，会导致发病率和死亡率上升。常用的技术是端端胆管吻合术和胆管空肠吻合术。已知这两种技术都与胆管吻合口漏和狭窄的高发生率相关。实验表明，胆总管侧侧吻合术优于端端吻合术。作者呈现了316例人类肝移植的结果，其中进行了胆总管侧侧吻合术。
对340例患者的370例移植手术的胆道并发症进行了评估。300例患者接受了原位肝移植，并进行了供体和受体胆总管的侧侧吻合。32例有胆道病变的患者接受了胆肠吻合术，8例患者因各种原因未进行侧侧吻合。在预先设定的时间点进行临床和实验室检查。所有患者在术后第5天和第42天常规进行X线胆管造影。对于怀疑有乳头狭窄的患者，进行内镜逆行胆管造影和乳头切开术。
肝移植术后早期（术后第0天至30天）观察到1例胆漏（0.3%）。在此期间未观察到胆总管吻合口狭窄。2例患者（0.6%）发生晚期胆管狭窄。300例原位移植中有4例（1.3%）观察到与T管相关的并发症。观察到与手术技术无关的并发症，包括乳头狭窄（5.7%）和缺血型胆管病变（3.0%），这些并发症在本质上比吻合口并发症或与T管相关的并发症更严重。乳头狭窄导致1.3%的患者频繁接受内镜干预和再次移植。
胆总管侧侧吻合术是一种安全的胆管重建技术，在人类原位肝移植术后技术并发症发生率较低。由保存损伤、动脉缺血、胆汁淤积和胆管炎引起的缺血型胆管病变可能是一种新的胆道并发症实体，这显著增加了人类肝移植后的发病率。因此，这种并发症应成为进一步研究的对象。
