目的:探讨活体肝移植(LDLT)胆管吻合术后胆管狭窄的经皮肝穿治疗的临床效果。
方法:这项回顾性研究检查了基线特征,程序细节,临床结果,8个月内引流导管拔除率,以及使用患者医疗记录和图像拔除导管后的复发。通过单变量和多变量分析评估8个月内引流导管拔除失败和引流导管拔除后胆道狭窄复发的危险因素。
结果:总共112名患者(53.4±8.79岁,91名男性)进行了评估。75例(70.0%)患者放置了多个引流导管。107例(95.5%)患者成功拔除引流导管。8个月内引流导管拔除失败与肝动脉并发症(p=0.034)和狭窄需要替代通道技术(p=0.034)有关。引流导管拔除后1、2、3和5年的累积一次通畅率为85.4%,79.8%,75.8%,和68.4%,分别。胆道狭窄的复发与未治疗的孤立的部门导管的存在有关(aHR,3.632;95%CI,1.086-12.150,p=0.037),并伴有胆漏(aHR,2.475;95%CI,1.090-5.621,p=0.031)。
结论:经皮经肝穿刺治疗LDLT胆管吻合术后胆管狭窄是有效的。由于这些患者经常发生多个狭窄,因此需要维护多个引流导管。
结论:•经皮肝穿治疗对活体肝移植(LDLT)胆管吻合术后胆管狭窄的治疗有效,尽管内窥镜方法可用于这种类型的重建。•由于多个复杂的狭窄,这些患者经常放置多个引流导管。•我们发现,引流导管拔除后的复发与部门导管的隔离和并发胆漏有关。
OBJECTIVE: To investigate clinical outcomes of percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT).
METHODS: This retrospective study examined baseline characteristics, procedural details, clinical outcomes, drainage catheter removal rate within 8 months, and recurrence after catheter removal using patients\' medical records and images. Risk factors for failure of drainage catheter removal within 8 months and recurrence of biliary stricture after drainage catheter removal were assessed via univariable and multivariable analyses.
RESULTS: A total of 112 patients (53.4 ± 8.79 years, 91 men) were evaluated. Multiple drainage catheters were placed in 75 patients (70.0%). Drainage catheters were successfully removed in 107 patients (95.5%). Failure of drainage catheter removal within 8 months was associated with hepatic artery complications (p = 0.034) and strictures requiring alternative passage techniques (p = 0.034). The cumulative primary patency rates after drainage catheter removal at 1, 2, 3, and 5 years were 85.4%, 79.8%, 75.8%, and 68.4%, respectively. Recurrence of biliary stricture was associated with the presence of an untreated isolated sectoral duct (aHR, 3.632; 95% CI, 1.086-12.150, p = 0.037) and with concurrent bile leaks (aHR, 2.475; 95% CI, 1.090-5.621, p = 0.031).
CONCLUSIONS: Percutaneous transhepatic treatment was effective for the treatment of biliary strictures after duct-to-duct biliary anastomosis in LDLT. Multiple drainage catheter maintenance was needed because multiple strictures often occurred in these patients.
CONCLUSIONS: • Percutaneous transhepatic treatments are useful and effective for the treatment of biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT), although an endoscopic approach is available for this type of reconstruction. • Multiple drainage catheters were frequently placed in these patients because of multiple complex strictures. • We found that recurrence after drainage catheter removal was associated with isolation of the sectoral duct and with concurrent bile leaks.