Distante V, Farouk M, Kurzawinski T R, Ahmed S W, Burroughs A K, Davidson B R, Rolles K
University Department of Surgery, School of Medicine, Royal Free Hospital, Hampstead, London, UK.
Transpl Int. 1996;9(2):126-30. doi: 10.1007/BF00336389.
The biliary complications in patients undergoing biliary reconstruction by duct-to-duct (D-D) anastomosis or with a Roux-en-Y loop (RL) at the time of liver transplantation for primary sclerosing cholangitis (PSC, 16 D-D, 10RL) or primary biliary cirrhosis (PBC, 31 D-D, 1 RL) were reviewed and compared. Patients were followed up for a mean period of 32 months. Extrahepatic biliary strictures occurred in 18.7%, 10% and 9.7% of DD-PSC, RL-PSC and DD-PBC patients, respectively, leaks in 6.2%, 20% and 6.4% DD-PSC, RL-PSC and DD-PBC patients, respectively (P = NS). Four intrahepatic biliary abnormalities developed in the PSC group. Duct-to-duct anastomosis did not significantly increase the risk of stricture formation or bile leaks in PSC patients compared to PBC patients. We conclude that duct-to-duct biliary reconstruction following liver transplantation for PSC is satisfactory unless the distal common bile duct is strictured.
回顾并比较了在原发性硬化性胆管炎（PSC，16例行端端吻合术[D-D]，10例行Roux-en-Y袢[RL]）或原发性胆汁性肝硬化（PBC，31例行D-D，1例行RL）肝移植时采用胆管对胆管（D-D）吻合术或带Roux-en-Y袢（RL）进行胆管重建的患者的胆道并发症。对患者进行了平均32个月的随访。肝外胆管狭窄分别发生在D-D-PSC、RL-PSC和D-D-PBC患者中的比例为18.7%、10%和9.7%，胆漏分别发生在D-D-PSC、RL-PSC和D-D-PBC患者中的比例为6.2%、20%和6.4%（P=无显著性差异）。PSC组出现了4例肝内胆管异常。与PBC患者相比，D-D吻合术在PSC患者中并未显著增加狭窄形成或胆漏的风险。我们得出结论，除非胆总管远端狭窄，否则PSC肝移植后胆管对胆管的胆道重建效果令人满意。
