肝移植胆道吻合及其并发症的处理

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Title:Management of the bile duct anastomosis and its complications after
liver transplantation
题目：肝移植胆道吻合及其并发症的处理
Author：Eric T. Castaldo, Mary T. Austin, C. Wright Pinson, Ravi S. Chari
Source: Transplantation reviews. 21 (2007) 26– 33

Abstract：The functional recreation of the biliary system has long been a source of morbidity in patients undergoing hepatic transplantation.The methods used to recreate a biliary system have undergone a metamorphosis over time. Gall bladder conduits and loop choledochojejunostomies have given way to duct-to-duct choledochocholedochostomies and the Roux-en-Y choledojejunostomy with resulting improvements in biliary outcomes. Stenting, stapling, and suture techniques have also evolved in an effort to improve transplant biliary outcomes. As the methods for the re-creation of the biliary system have evolved, so too have the methods used to deal with the subsequent complications. Primary surgical exploration has given way to less invasive percutaneous and endoscopic techniques. This article focuses on aspects of the surgical management of the bile duct anastomosis during liver transplantation and the subsequent management of biliary complications.
摘要：在肝移植患者中，胆道系统功能重建已经成为一个长期影响病死率的原因。过去常用来重建胆道系统的方法已经随着时间的延续而改变。胆囊管胆总管空肠环状吻合已经被胆总管端端吻合术和胆总管空肠Roux-en-Y吻合术所代替，这使得胆汁排出量增加。支架、U形钉固定和缝合技术发展也促进移植术后胆汁排出量增加。随着胆道系统重建方法的改进，这些方法也已经开始用来治疗移植术后继发性并发症。早期的手术探查已经被创伤更少的经皮内镜检查代替。本论文主要讨论肝移植时胆管吻合技术和胆道并发症处理。
Conclusion：Over time, the field of liver transplantation and surgery has undergone evolution that has resulted in improved patient outcomes. The techniques associated with reconstruction of the biliary system have also undergone several changes. Gall bladder conduits and loop choledochojejunostomies have given way to duct-to-duct choledochocholedochostomies and the RYCJ with resulting improvements in biliary outcomes. In addition, the routine use of T tubes is falling out of favor. Stenting, stapling, and suture techniques have also evolved in an effort to improve transplant biliary outcomes. As the methods used for the re-creation of a biliary system have evolved, so too have the methods of diagnosis and management of the complications associated with it.Surgical exploration, the first line modality for diagnosis and therapy in a previous era, has given way to less invasive percutaneous and endoscopic techniques aimed at diagnosis and treatment. Biliary complications still remain a significant source of
patient morbidity and mortality in liver transplantation. The problems are complex and the methods used in caring for these patients are diverse.
结论：随着肝移植和肝脏外科领域的发展，患者的生存率逐渐提高。胆道重建技术也经历了几次变革。胆囊管胆总管空肠环状吻合已经被胆总管端端吻合术和胆总管空肠Roux-en-Y吻合术所代替，这使得胆汁排出量增加。另外，常规使用T型管也是一个好的发展。支架、U形钉固定和缝合技术发展也促进移植术后胆汁排出量增加。随着胆道系统重建方法的改进，这些方法也已经开始用来诊断和治疗移植术后相关并发症。手术探查这个早期的诊断治疗一线方案已经被创伤更少的经皮内镜诊疗技术代替。
胆道并发症一直是肝移植患者术后发病率和死亡率的重要原因。胆道并发症是非常复杂的，其治疗方法也是多种多样的。

题目：肝移植胆道吻合及其并发症的处理

摘要：在肝移植患者中，胆道系统功能重建已经成为一个长期影响病死率的原因。过去常用来重建胆道系统的方法已经随着时间的延续而改变。胆囊管胆总管空肠环状吻合已经被胆总管端端吻合术和胆总管空肠Roux-en-Y吻合术所代替，这使得胆汁排出量增加。支架、U形钉固定和缝合技术发展也促进移植术后胆汁排出量增加。随着胆道系统重建方法的改进，这些方法也已经开始用来治疗移植术后继发性并发症。早期的手术探查已经被创伤更少的经皮内镜检查代替。本论文主要讨论肝移植时胆管吻合技术和胆道并发症处理。

结论：随着肝移植和肝脏外科领域的发展，患者的生存率逐渐提高。胆道重建技术也经历了几次变革。胆囊管胆总管空肠环状吻合已经被胆总管端端吻合术和胆总管空肠Roux-en-Y吻合术所代替，这使得胆汁排出量增加。另外，常规使用T型管也是一个好的发展。支架、U形钉固定和缝合技术发展也促进移植术后胆汁排出量增加。随着胆道系统重建方法的改进，这些方法也已经开始用来诊断和治疗移植术后相关并发症。手术探查这个早期的诊断治疗一线方案已经被创伤更少的经皮内镜诊疗技术代替。
胆道并发症一直是肝移植患者术后发病率和死亡率的重要原因。胆道并发症是非常复杂的，其治疗方法也是多种多样的。