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Hepatic artery bridging lessens temporary ischemic injury to bile canaliculi

World Journal of Gastroenterology 2015年第35期21卷 10113-10125页

作者： Jia-Zhong Wang Yang Liu Jin-Long Wang Le Lu Ya-Fei Zhang Hong-Wei Lu Yi-Ming Li Department of General Surgery the Second Affiliated HospitalXi'an Jiaotong University School of Medicine

AIM: To study whether transfer of blood between the right gastroepiploic artery and gastroduodenal artery could lessens the damage to bile ***: Forty male Bama miniature pigs were divided into four groups as follows: a control group, two hepatic artery ischemia groups(1 h and 2 h), and a hepatic artery bridging group. The hemodynamics of the hepatic artery in the hepatic artery bridging group was measured using color Doppler ultrasound. Morphological changes in the bile canaliculus were observed by transmission electron microscopy. Cofilin, heat shock protein 27 and F-actin expression was detected by immunohistochemistry, Western blot, and real-time polymerase chain reaction. Terminal deoxynucleotidyl transferase-mediated nick end-labeling method was used to evaluate liver injury. RESULTS: The hemodynamics was not changed in the hepatic artery bridging group. The microvilli in the bile canaliculus were impaired in the two hepatic artery ischemia groups. The down-regulation of cofilin and F-actin and up-regulation of heat shock protein 27 were observed in the two hepatic artery ischemia groups, while there were no significant differences between thecontrol group and hepatic artery bridging ***: Hepatic artery ischemia aggravates damage to bile canaliculi, and this damage can be diminished by a hepatic artery bridging duct.

关键词： nonanastomotic biliary strictures Hepatic artery i

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Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

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World Journal of Transplantation 2015年第4期5卷 300-309页

作者： Stefan Kienlein Wenzel Schoening Anne Andert Daniela Kroy Ulf Peter Neumann Maximilian Schmeding Department of General Visceral and Transplantation SurgeryUniversity Hospital Aachen Department of Gastroenterology and Hepatology University Hospital Aachen

AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver ***: 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 ***: 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 stric

关键词： Liver transplantation Biliary complications Anastomotic stenosis Ischemic type biliary lesion nonanastomotic strictures Bile leak Ischemic time Biliary drain complications

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