담도-담도 문합술을 시행한 100례의 생체 부분 간이식 환자에서 담도합병증의 위험인자 분석
Duct-to-Duct Biliary Reconstructions and Complications in 100 Living Donor Liver Transplantation
- 주제(키워드) Living donor liver transplantation , Duct-to-duct anastomosis , Biliary complication
- 발행기관 아주대학교
- 지도교수 왕희정
- 발행년도 2010
- 학위수여년월 2010. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000010361
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background. The biliary complications in duct-to-duct biliary reconstruction of right or left lobe living-donor liver transplantation (LDLT) have been reported various in incidence up to 40 %. And that could result in serious morbidity or mortality to the recipient’s. We evaluated the risk factors for biliary complication and feasible surgical procedure of duct-to-duct reconstruction in adult LDLT. Methods. From February 2005 to March 2008, 100 cases of adult LDLT with duct-to-duct biliary reconstruction were performed. 64 right lobe grafts, 33 left lobe grafts, and 3 right lateral grafts were used. There were four types of duct-to-duct procedure; all interrupted suture with 6-0 prolene (Group 1, n = 9), continuous posterior and interrupted anterior wall suture with 6-0 prolene (Group 2, n = 49), all continuous suture with 7-0 prolene (Group 3, n = 26), and all continuous 7-0 prolene suture with external stent (Group 4, n = 16). Biliary complications were defined as anastomosis stricture and leakage. Results. 34 patients experienced biliary complications during follow-up time (median 27 months). The incidence of stricture was 27% and that of leakage was 8%. There were no risk factors of biliary complication associated with peri-operative, intra-operative, and anatomical characteristics, except types of duct-to-duct procedure. Group 1 and 2 patients had higher incidence of biliary stricture than Group 3 and 4 (43.1% vs. 4.7%, P = 0.00). And Group 3 patients experienced higher incidence of bile leakage than other groups (23.1% vs. 2.7%, P = 0.004). Conclusion. The technical type of biliary reconstruction is the factor affecting biliary complication following duct-to-duct anastomosis in LDLT. Duct-to-duct biliary anastomosis with 7-0 monofilament suture and small external stent is a feasible procedure in LDLT to significantly reduce the incidence of biliary complication.
more목차
ABSTRACT i
TABLE OF CONTENTS iii
LIST OF TABLE iv
LIST OF FIGURE v
I. INTRODUCTION 1
II. PATIENTS AND METHODS 3
A.Preparation of Graft Bile duct 5
B.Recipient Operation 7
C.Diagnosis and Treatment of Biliary Complications 11
D.Statistical Analysis 12
III. RESULTS 13
IV. DISCUSSION 24
V. CONCLUSION 32
VI. REFERENCES 33
VII. 국문요약 36
LIST OF TABLE
Table 1. Numbers of graft, bile ducts and biliary anastomosis. 14
Table 2. Risk factor analysis for biliary stricture. 20
Table 3. Risk factor analysis for biliary leakage. 22
LIST OF FIGURE
Figure 1. Types of procedures and materials in duct-to-duct anastomosis. 9
Figure 2. Comparisons of biliary complication-free survival rates between Groups. 18
Figure 3. A pitfall in technique of graft’s duct slid into recipient’s duct to 27
overcome size discrepancy
