国际肝胆胰疾病杂志（英文版）
國際肝膽胰疾病雜誌（英文版）
국제간담이질병잡지（영문판）
Hepatobiliary & Pancreatic Diseases International
2013年
1期
42-46
,共5页
right-liver%endoscopic treatment%living donor liver transplantation%biliary anastomotic stricture%duct-to-duct anastomosis%hepaticojejunostomy
BACKGROUND:?Conversion?hepaticojejunostomy?is?considered?the? salvage? intervention? for? biliary? anastomotic? stricture,?a? common? complication? of? right-liver? living? donor? liver?transplantation? with? duct-to-duct? anastomosis,? after? failed?endoscopic?treatment.?The?aim?of?this?study?is?to?compare?the?outcomes?of?side-to-side?hepaticojejunostomy?with?those?of?end-to-side?hepaticojejunostomy. <br> METHODS:??Prospectively?collected?data?of?402?adult?patients?who?had?undergone?right-liver?living?donor?liver?transplantation?with? duct-to-duct? anastomosis? were? reviewed.? Diagnosis?of?biliary?anastomotic?stricture?was?made?based?on?clinical,?biochemical,?histological?and?radiological?results.?Endoscopic?treatment?was?the?ifrst-line?treatment?of?biliary?anastomotic?stricture. <br> RESULTS:?Interventional?radiological?or?endoscopic?treatment?failed?to?correct?the?biliary?anastomotic?stricture?in?13?patients,?so?they?underwent?conversion?hepaticojejunostomy.?Ten?of?them? received? end-to-side? hepaticojejunostomy? and? three?received?side-to-side?hepaticojejunostomy.?In?the?end-to-side?group,?two?patients?sustained?hepatic?artery?injury?requiring?repeated? microvascular? anastomosis,? two? developed? re-stenosis?requiring?further?percutaneous?transhepatic?biliary?drainage?and?balloon?dilatation,?and?two?required?revision?hepaticojejunostomy.?In?the?side-to-side?group,?one?patient?developed?re-stenosis?requiring?further?endoscopic?retrograde?cholangiography?and?balloon?dilatation.?No?re-operation?was?needed?in?this?group.?Otherwise,?outcomes?in?the?two?groups?were?similar?in?terms?of?liver?function?and?graft?survival. <br> CONCLUSIONS:?Despite? the? similar? outcomes,? side-to-side?hepaticojejunostomy? may? be? a? better? option? for? bile? duct?reconstruction? after? failed? interventional? radiological? or?endoscopic?treatment?because?it?can?decrease?the?chance?of?hepatic?artery?injury?and?allows?future?endoscopic?treatment?if?re-stricture?develops.?However,?more?large-scale?studies?are?warranted?to?validate?the?results.
