Biliary reconstruction and treatment of biliary complications in orthotopic live r transplantation
- VernacularTitle:同种原位肝移植术的胆管重建及其术后并发症的防治
- Author:
Tianfu WEN
;
Lunan YAN
;
Bo LI
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Bile ducts;
Postoperative complication
- From:
Chinese Journal of Organ Transplantation
2005;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the technique of b iliary reconstruction and treatment of biliary complications in orthotopic liver transplantation (OLT). Methods From Feb. 1999 to Jan. 2003, OLT was performed in 103 patients with end-stage l iver disease. OLT was performed with standard techniques with or without a veno -venous bypass. Reconstructions of biliary tract were performed using choledoc hocholedochostomy (CDC) or Roux-en-Y choledochoje- junostomy (RCDJ). CDC was carried out in 94 cases, with T tube (CDCT) in 62 cases and without T tube (CDCO ) in 32 cases respectively. Among the 32 cases without T tube, 11 had a small tu be placed in the common bile duct through the recipient cystic duct. RCDJ was pe rformed in 9 cases without internal stent. Diagnosis of the biliary complication s after OLT was based on the clinical manifestations, ultrasound findings, MRCP and ERCP. All the patients were followed up regularly after discharge for 12 to 48 months. Results The overall incidence of biliary complications in 103 patients after OLT was 7 .8% (8/103). Of the 62 cases of CDCT posttransplant, biliary complications occ urred in 6 cases ( 9.6% ), including 4 cases of bile leaks following OLT and 2 cases of bile leaks following T-tube removed. Of the 32 patients subject to CD CO, 1 ( 3.1% ) had stricture of anastomosis. Of the 9 cases subject to RCDJ, one patient was complicated with bile leaks at the anasto mosis. Two cases of the bile leaks were drained reoperatively, and others were k ept adequate drained. The patient with stricture of CDCO was cured by balloon di latation and stent placed endoscopically. No death associated with biliary compl ications occurred. Conclusions Bile leaks and stricture of anatomosis are the common biliary complications afte r OLT. Good blood supply to biliary tract and surgical technique are the keys to prevent biliary complications after OLT. The timely endoscopical and radiologic al technique is a valuable nonoperative precedure for diagnosis and treatment of biliary complicat ions.
