肝移植术后胆道并发症的防治

目的探讨肝移植术后胆道并发症的防治措施。方法回顾性研究2002年4月至2007年2月我中心249例肝移植的临床资料。结果249例肝移植患者中,31例发生胆道并发症(12.45%),其中胆漏16例(早期14例、晚期2例),吻合口狭窄9例,非吻合口狭窄6例。并发胆漏患者中,3例经ERCP放置鼻胆管引流治愈,4例在B超引导下行腹腔穿刺置管引流治愈,7例轻度胆漏患者经延长腹腔引流管放置时间治愈,2例晚期胆漏患者充分引流后治愈。吻合口狭窄患者中,5例行PTCD球囊扩张术,4例行ERCP球囊扩张术,共有3例放置了胆道支架,现均存活良好。非吻合口狭窄患者中,2例二次肝移植后治愈,另4例行PTCD联合胆道镜治疗,2例治愈,2例恢复不佳。结论完善手术技术、缩短移植物冷热缺血时间及保护胆道血供是预防肝移植术后胆道并发症的重要措施,个体化治疗,多可取得良好疗效。

Prevention and treatment of biliary tract complications after liver transplantation

Objective To discuss the prevention and treatment of biliary tract complications after liver transplantation.Methods Clinical data of 249 patients who underwent liver transplantation between April 2002 and February 2007 were studied retrospectively.Results There were 31 cases of biliary tract complications in 249 cases (12.45%).There were 16 cases of biliary leak (including 14 cases in early-stage and 2 cases in advanced-stage),9 cases of anastomotic biliary stricture and 6 cases of non-anastomotic biliary stricture.Among the patients with biliary leak,3 cases were cured by nasobiliary drainage through ERCP.Four cases were cured by abdominal paracentesis and drainage tube under the guidance of B ultrasound.After prolonging the time of abdominal drainage,7 cases of mild biliary leak were cured.Two cases of advanced-stage biliary leak were cured through the full drainage.Among the patients with anastomotic biliary stricture,5 cases were subjected to sacculus dilatation through PTCD and 4 cases to sacculus dilatation through ERCP.In 9 cases,biliary tract bracket was placed in 3 cases.Among the patients with non-anastomotic biliary stricture,2 cases received second liver transplantation and cured,and 4 cases were subjected to PTCD in combination with choledochoscope:2 cases were cured and 2 cases got worse.Conclusion Improving operative techniques,shortening cold-warm ischemic time of the grafts and protecting the blood supply of biliary tract are the important steps to prevent biliary tract complications after liver transplantation.Individualized treatment can obtain satisfactory curative effects.