Kasahara M, Egawa H, Takada Y, Oike F, Sakamoto S, Kiuchi T, Yazumi S, Shibata T, Tanaka K
器官移植和免疫科，医学系，京都大学，京都，日本

目标：评价行胆总管空肠端端吻合术或胆总管空肠Roux-en-Y吻合术的肝右叶LDLT患者术后胆道并发症的发病率。

背景资料：胆道并发症依然是肝移植术后最严重的问题之一。目前还没有进行过大规模的系列研究来比较两种技术的异同。本研究回顾性评价了胆道重建中使用的方法与所报道的并发症之间的关系。

方法：在1998年2月至2004年6月期间，321例患者进行了肝右叶LDLT。其中121例患者进行的是胆总管空肠Roux-en-Y吻合术，192例患者进行的是端端吻合术，8例患者为Roux-en-Y吻合术联合端端吻合术。我们分析了移植物的胆管和吻合口数量、吻合模式、支架的使用以及对胆道并发症的管理等。

结果：胆道并发症的总发病率为24.0%。单变量分析显示，肝动脉并发症、巨细胞病毒感染和血型不相容是出现胆道并发症的重要风险因素。在Roux-en-Y吻合术中，胆漏和狭窄的发病率分别为12.4%和8.3%，端端吻合术中则分别为4.7%和26.6%。由此可见，端端吻合术中胆漏的发病率明显更低，而狭窄的发病率却明显更高。然而，74.5%的狭窄可以通过内窥镜治疗来管理。

结论：作者发现端端吻合小组中，患者发生胆道狭窄的概率更高。由于具有更高的胆肠连续性、胆漏的发病率更低，且内镜容易推入，所以端端吻合术是肝右叶LDLT的良好技术选择。

Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients
Kasahara M, Egawa H, Takada Y, Oike F, Sakamoto S, Kiuchi T, Yazumi S, Shibata T, Tanaka K
Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
OBJECTIVE: To assess the incidence of biliary complications after right lobe living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy or Roux-en-Y choledochojejunostomy reconstruction.

SUMMARY BACKGROUND DATA: Biliary tract complications remain one of the most serious morbidities following liver transplantation. No large series has yet been carried out to compare the 2 techniques in LDLT. This study undertook a retrospective assessment of the relation between the method of biliary reconstruction used and the complications reported.

METHODS: Between February 1998 and June 2004, 321 patients received right lobe LDLT. Biliary reconstruction was achieved with Roux-en-Y choledochojejunostomy in 121 patients, duct-to-duct choledochocholedochostomy in 192 patients, and combined Roux-en-Y and duct-to-duct choledochocholedochostomy in 8 patients. The number of graft bile duct and anastomosis, mode of anastomosis, use of stent tube, and management of biliary complications were analyzed.

RESULTS: The overall incidence of biliary complications was 24.0%. Univariate analysis revealed that hepatic artery complications, cytomegalovirus infections, and blood type incompatibility were significant risk factors for biliary complications. The respective incidence of biliary leakage and stricture were 12.4% and 8.3% for Roux-en-Y, and 4.7% and 26.6% for duct-to-duct reconstruction. Duct-to-duct choledochocholedochostomy showed a significantly lower incidence of leakage and a higher incidence of stricture; however, 74.5% of the stricture was managed with endoscopic treatment.

CONCLUSIONS: The authors found an increase in the biliary stricture rate in the duct-to-duct choledochocholedochostomy group. Because of greater physiologic bilioenteric continuity, less incidence of leakage, and easy endoscopic access, duct-to-duct reconstruction represents a feasible technique in right lobe LDLT.

[责任编辑:刘聪]