Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

被引:0
作者
Satoshi Yamamoto
Yoshinobu Sato
Hiroshi Oya
Hideki Nakatsuka
Takashi Kobayashi
Yoshiaki Hara
Takaoki Watanabe
Isao Kurosaki
Katsuyoshi Hatakeyama
机构
[1] Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
[2] Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
关键词
Living donor; Liver transplantation; Biliary anastomotic complication; Duct-to-Duct anastomosis; Roux-en-Y anastomosis;
D O I
暂无
中图分类号
R657.3 [肝及肝管];
学科分类号
1002 ; 100210 ;
摘要
AIM: To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction. METHODS: A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS: The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no signifi cant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was signifi cantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049). CONCLUSION: Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refi nement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a signifi cant reduction of BACs in D-D.
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页码:4236 / 4241
页数:6
相关论文
共 16 条
[1]  
Biliary complications after living donor adult liver transplantation*[J] . Alessandro Giacomoni,Andrea Lauterio,Abdallah O. Slim,Angelo Vanzulli,Antonella Calcagno,Iacopo Mangoni,Luca S. Belli,Andrea De Gasperi,Luciano De Carlis.Transplant International . 2006 (6)
[2]  
Long‐term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation[J] . Shin Hwang,Sung‐Gyu Lee,Kyu‐Bo Sung,Kwang‐Min Park,Ki‐Hun Kim,Chul‐Soo Ahn,Young‐Joo Lee,Sung‐Koo Lee,Gyu‐Sam Hwang,Deok‐Bog Moon,Tae‐Yong Ha,Dong‐Sik Kim,Jae‐Pil Jung,Gi‐Won Song.Liver Transpl . 2006 (5)
[3]   T-tube drainage for biliary stenosis after living donor liver transplantation [J].
Hashimoto, M ;
Sugawara, Y ;
Tamura, S ;
Kishi, Y ;
Matsui, Y ;
Kaneko, J ;
Makuuchi, M .
TRANSPLANTATION, 2006, 81 (02) :293-295
[4]   Duct-to-duct biliary reconstruction in adult living-donor liver transplantation [J].
Dulundu, E ;
Sugawara, Y ;
Sano, K ;
Kishi, Y ;
Akamatsu, N ;
Kaneko, J ;
Imamura, H ;
Kokudo, N ;
Makuuchi, M .
TRANSPLANTATION, 2004, 78 (04) :574-579
[5]   New hepatic vein reconstruction by double-expansion of outflow capacity of left-sided liver graft in living-donor liver transplantation [J].
Sato, Y ;
Yamamoto, S ;
Takeishi, T ;
Nakatsuka, H ;
Kokai, H ;
Hatakeyama, K .
TRANSPLANTATION, 2003, 76 (05) :882-884
[6]   Feasibility of duct-to-duct biliary reconstruction in left-lobe adult-living-donor liver transplantation [J].
Soejima, Y ;
Shimada, M ;
Suehiro, T ;
Kishikawa, K ;
Minagawa, R ;
Hiroshige, S ;
Ninomiya, M ;
Shiotani, S ;
Harada, N ;
Sugimachi, K .
TRANSPLANTATION, 2003, 75 (04) :557-559
[7]   Biliary reconstruction and complications of right lobe live donor liver transplantation [J].
Fan, ST ;
Lo, CM ;
Liu, CL ;
Tso, WK ;
Wong, J .
ANNALS OF SURGERY, 2002, 236 (05) :676-683
[8]   Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction [J].
Kawachi, S ;
Shimazu, M ;
Wakabayashi, G ;
Hoshino, K ;
Tanabe, M ;
Yoshida, M ;
Morikawa, Y ;
Kitajima, M .
SURGERY, 2002, 132 (01) :48-56
[9]   Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma [J].
Kim, HK ;
Chung, YH ;
Song, BC ;
Yang, SH ;
Yoon, HK ;
Yu, E ;
Sung, KB ;
Lee, YS ;
Lee, SG ;
Suh, DJ .
JOURNAL OF CLINICAL GASTROENTEROLOGY, 2001, 32 (05) :423-427
[10]  
Biliary Anastomosis in Living Related Liver Transplantation Using the Right Liver Lobe: Techniques and Complications[J] . Giuliano Testa,Christoph E. Broelsch.Liver Transplantation . 2000 (6)