肝移植后胆道并发症的诊断和处理

目的 研究肝移植后胆道并发症的诊断和处理及分析相关因素。方法 回顾性研究Pittsburgh移植中心96例肝移植病人。结果 94例（97次移植）存活2d以上的病人，92例为端端＋T管的胆道吻合，随访时间为5.8个月（0.3-10.2个月）。分析发现92例病人中8例有胆道并发症（8.51%）；T管拔除时胆漏2例，术后早期胆漏2例，狭窄2例。75％胆道并发症有诱因，诱因：肝动脉狭窄2例，其中1例合并严重排斥反应；肝动脉血栓3例；供一受体胆管直径不匹配1例。冷缺血时间无显著性差异。5例有肝动脉血栓和（或）狭窄＞50％行再移植，另3例无肝动脉血栓和（或）狭窄＜50％经皮穿刺和内窥镜＋支架或行气囊扩张，所有病人均获得良好疗效。结论 肝移植术后胆道并发症发生率为8.51％（胆－胆端端吻合＋T管），胆道狭窄晚于胆漏，肝动脉检塞和（或狭窄是最重要的相关因素；无肝动脉栓塞和（或）狭窄，则无需手术治疗，若有肝动脉栓塞和（或）狭窄＞50％，应尽早做再次肝移植。

Diagnosis and management of biliary tract complications after liver transplantation

Objective To study the diagnosis and management of biliary tract complications after liver transplantation and analyze relevant factors. Methods A review was made of 96 patients' data collected prospectively. Then the results were confirmed by retrospective review. Results A total of 94 patients (97 grafts) survived for over 2 days after the transplantation. Of these 94 patients, 92 had an end to end biliary anastomosis with T tube. The average follow up time was 5.8 months (0 3 10 2 months). The analysis of these 92 patients showed that 8 (8.51%) had complications: leaks at T tube in 2, leaks at the early stage in 2, strictures and leaks in 2 and strictures in the other 2. Predisposing factors were found in 75% of the patients with biliary tract complications. The factors were: hepatic artery stenosis in 2, the stenosis in combined with severe rejection in 1, hepatic artery thrombosis in 3 and donor recipient bile duct mismatch in the left 1. There was no difference in cold ischemic time. Re transplantation was performed in 5 patients with HA thrombosis and/or stenosis >50%. Endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation were done in 3 patients with HA thrombosis and/or stenosis <50%. Conclusions A total of 8.51% of patients with end to end biliary anastomosis have biliary tract complications. Biliary strictures appears later than leaks. Without hepatic arterial thrombosis and/or stricture, there is no need for surgery. With hepatic arterial thrombosis and/or stricture >50%, retransplantation is needed as early as possible.