성인간 생체 부분 간이식에서의 담도계 합병증
Biliary Complications after Living Donor Liver Transplanstation
안철수, 이승규, 이영주, 박광민, 황신, 최동락, 나양원, 박동은, 주선형, 전장용, 민병철,
소속 상세정보
안철수 ( Ahn Chul-Soo )
울산대학교 의과대학 서울중앙병원 외과학교실
이승규 ( Lee Sung-Gyu )
울산대학교 의과대학 서울중앙병원 일반외과
이영주 ( Lee Young-Joo )
울산대학교 의과대학 서울중앙병원 외과학교실
박광민 ( Park Kwang-Min )
울산대학교 의과대학 서울중앙병원 외과학교실
황신 ( Hwang Shin )
울산대학교 의과대학 서울중앙병원 외과학교실
최동락 ( Choi Dong-Lak )
울산대학교 의과대학 서울중앙병원 외과학교실
나양원 ( Nah Yang-Won )
울산대학교 의과대학 서울중앙병원 일반외과
박동은 ( Park Dong-Yeun )
울산대학교 의과대학 서울중앙병원 외과학교실
주선형 ( Joo Sun-Hyung )
울산대학교 의과대학 서울중앙병원 외과학교실
전장용 ( Jun Jang-Yong )
울산대학교 의과대학 서울중앙병원 외과학교실
민병철 ( Min Pyung-Chul )
울산대학교 의과대학 서울중앙병원 외과학교실
KMID : 0371320010610020188
Abstract
Purpose
Living donor liver transplantation (LDLT) has several difficulties in biliary reconstruction of the small and thin bile duct, the short stump, and multiple openings.
Methods
76 cases of LDLT performed in Asan Medical Center from Jan. 1999 to Feb. 2000 were reviewed retrospectively.
Results
The causative diseases in this group were hepatitis B associated cirrhosis 47, hepatoma 16, fulminent hepatic failure 6, secondary biliary cirrhosis 3, alcoholic cirrhosis 2, hepatitis C associated cirrhosis 1, and Wilson’s disease 1cases. Right
lobe
graft was done in 54 cases, and a left lobe graft was done in 22. All bile duct reconstructions were done as Roux-en-Y hepaticojejunostomy, single anastomosis in 59, a double anastomosis in 15, and a triple anastomosis in 2cases. Biliary leakage
occurred in 7 cases (10.4%), and percutaneous drainage subsequently being done. Post leakage bile duct stricture occurred in 2 cases (2.6%). Delayed bile duct stricture occurred in 3 cases. All stricture cases were treated with PTBD and repeated
balloon
dilatation. There was no difference between the right and left lobe graft in terms of bile leakage. However, stricture, occurred only in the right lobe graft. Bile duct stricture occurred more frequently in the multiple bile ducts (5% in single
duct,
13.3% in double ducts, but there’s no significance).
Conclusion
The prevalence of biliary complication of LDLT was about 10%. In addition, there were more complicationsin the right lobe and multiple bile duct openings. Therefore, careful design and delicate hepatic parenchymal dissection is important to
obtain
a
single duct and safe cut surface of the graft. To avoid severe complications such as an intrahepatic abscess or stone, early diagnosis and treatment of biliary complications is essential.
키워드
생체 부분 간이식; 담도계 합병증; Living donor liver transplantation (LDLT); Biliary complication;
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