PDF(Pubmed)
Abstract：
With an incidence exceeding 30%, biliary complications after pediatric liver transplantation remain a great challenge. In addition, the database includes numerous controversial papers about the safety of duct-to-duct anastomosis compared to Reux-en-Y hepaticojejunostomy for pediatric living donor liver transplantation (LDLT). We aim to compare the two techniques in pediatric LDLT by conducting a systematic review and meta-analysis. PUBMED, Web of Science, Scopus, and Cochrane Library were searched for eligible studies from 1989 to October 2022. According to our eligibility criteria, seven articles (561 pediatric LDLT) were included in our study. On one hand, DD anastomosis is associated with a higher rate of biliary stricture in comparison to RYHJ (OR: 2.47, 95% CI = 1.20-5.09, P = 0.01; I2 = 12%). On the other hand, the incidence of cholangitis was higher in RYHJ (OR: 0.10 95% CI = 0.01- 0.84, P = 0.03; I2 = 0%). However, there was no significant difference in the overall incidence of complications, leakage and mortality between the two groups (overall incidence of complication OR: 1.12, 95% CI = 0.34-3.68, P = 0.86; I2 = 62%), (Leakage OR: 2.22, 95% CI = 0.79-6.23, P = 0.13; I2 = 18%) and (Mortality OR: 2.53, 95% CI = 0.61-10.57, P = 0.30; I2 = 0%). In conclusion, with a lower incidence of cholangitis, an equal overall incidence of biliary complication, and the possibility of RY conversion in case of stricture, DD anastomosis offers a feasible, safe, and more physiological alternative to RYHJ for pediatric LDLT.
摘要：
发病率超过30%，小儿肝移植术后胆道并发症仍然是一个巨大的挑战。此外,该数据库包括许多有争议的论文,内容涉及导管-导管吻合术与Reux-en-Y肝空肠吻合术相比用于儿童活体肝移植(LDLT)的安全性.我们的目标是通过进行系统评价和荟萃分析来比较这两种技术在小儿LDLT中的应用。pubmed,WebofScience,Scopus,从1989年至2022年10月，搜索了Cochrane图书馆的合格研究。根据我们的资格标准，我们的研究纳入了7篇文献(561篇儿科LDLT).一方面,与RYHJ相比，DD吻合与较高的胆道狭窄率相关（OR：2.47，95％CI=1.20-5.09，P=0.01；I2=12％）。另一方面,RYHJ组胆管炎发生率较高(OR:0.1095%CI=0.01-0.84,P=0.03;I2=0%).然而,并发症的总体发生率没有显着差异，两组之间的渗漏和死亡率（并发症的总发生率OR：1.12，95％CI=0.34-3.68，P=0.86；I2=62％），（渗漏OR：2.22，95％CI=0.79-6.23，P=0.13；I2=18％）和（死亡率OR：2.53，95％CI=0.61-10.57，P=0.30；I2=0％）。总之,胆管炎的发病率较低，胆道并发症的总体发生率相等，以及在狭窄情况下RY转换的可能性，DD吻合术提供了一种可行的，安全,RYHJ对小儿LDLT的生理选择。
