AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly est...AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%展开更多
目的探讨肠镜下长城式切开环切法治疗吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoid,PPH)术后重度吻合口狭窄的临床疗效。方法选取2013年1月至2018年12月于大连大学附属新华医院收治的40例PPH术后重度吻合口狭窄患者,根...目的探讨肠镜下长城式切开环切法治疗吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoid,PPH)术后重度吻合口狭窄的临床疗效。方法选取2013年1月至2018年12月于大连大学附属新华医院收治的40例PPH术后重度吻合口狭窄患者,根据随机数字表法分成对照组和研究组各20例,研究组采用肠镜下长城式切开环切法治疗,而对照采用经肛多段切开结扎法治疗,比较分析两组患者围手术期指标和随访指标。结果在围手术期指标的两组分析中,发现研究组手术时间、术中出血量、术后疼痛评分、术后排便时间及术后排便时出血发生率显著优于对照组,其差异有统计学意义(P<0.05)。在随访指标的两组分析中,发现两组术后直肠静息压显著低于两组术前直肠静息压(P<0.05);但研究组临床治愈率、临床有效率及术后吻合口狭窄再发生率与对照组相比无差异(P>0.05)。结论在PPH术后重度吻合口狭窄的治疗上肠镜下长城式切开环切法疗效类似于业内认同的经肛多段切开结扎法,其操作安全、可行、微创、便捷,其临床疗效显著,值得临床推广应用。展开更多
文摘AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%
文摘目的探讨肠镜下长城式切开环切法治疗吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoid,PPH)术后重度吻合口狭窄的临床疗效。方法选取2013年1月至2018年12月于大连大学附属新华医院收治的40例PPH术后重度吻合口狭窄患者,根据随机数字表法分成对照组和研究组各20例,研究组采用肠镜下长城式切开环切法治疗,而对照采用经肛多段切开结扎法治疗,比较分析两组患者围手术期指标和随访指标。结果在围手术期指标的两组分析中,发现研究组手术时间、术中出血量、术后疼痛评分、术后排便时间及术后排便时出血发生率显著优于对照组,其差异有统计学意义(P<0.05)。在随访指标的两组分析中,发现两组术后直肠静息压显著低于两组术前直肠静息压(P<0.05);但研究组临床治愈率、临床有效率及术后吻合口狭窄再发生率与对照组相比无差异(P>0.05)。结论在PPH术后重度吻合口狭窄的治疗上肠镜下长城式切开环切法疗效类似于业内认同的经肛多段切开结扎法,其操作安全、可行、微创、便捷,其临床疗效显著,值得临床推广应用。
