한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제14권4호
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  • Pages.219-226
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  • 2010
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

생체간이식에서 담도 문합 방법: 국내 9개 간이식 병원 설문 조사 분석

Surgical Technique of Biliary Reconstruction in Adult-to-Adult Living Donor Liver Transplantation: Survey of 9 Major Centers in Korea

  • 이남준 (서울대학교 의과대학 외과학교실) ;
  • 권준혁 (성균관대학교 의과대학 삼성의료원 외과학교실) ;
  • 김건국 (가천의과학대학교 길병원 외과학교실) ;
  • 김봉완 (아주대학교 의과대학 아주대학교병원 외과학교실) ;
  • 유영경 (가톨릭대학교 의과대학 외과학교실) ;
  • 최진섭 (연세대학교 의과대학 외과학교실) ;
  • 하태용 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 한영석 (대구가톨릭대학교 의과대학 외과학교실) ;
  • 이광웅 (서울대학교 의과대학 외과학교실)
  • Yi, Nam-Joon (Deparment of Surgery Seoul National University College of Medicine) ;
  • Kwon, Choon-Hyuck David (Deparment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Keon-Kuk (Deparment of Surgery, Gachon Medical School, Gil Medical Center) ;
  • Kim, Bong-Wan (Deparment of Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • You, Young-Kyoung (Deparment of Surgery, The Catholic University of Korea, College of Medicine) ;
  • Choi, Jin-Sub (Deparment of Surgery, Yonsei University College of Medicine) ;
  • Ha, Tae-Yong (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Han, Young-Seok (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Kwang-Woong (Deparment of Surgery, Seoul National University College of Medicine)
  • 발행 : 2010.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles' heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. Methods: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). Results: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient's common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the $2^{nd}$ order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts' openings, but each duct was separately anastomosed to the recipients' bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. Conclusion: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.

키워드

참고문헌

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