肝移植术后胆道并发症的诊断与治疗

目的 探讨肝移植术后胆道并发症的诊断与治疗.方法 分析2007-2009年肝移植术后不同类型胆道并发症的患者的临床资料,评价胴道并发症的类型,处理方式及术后恢复情况.结果 肝移植术后胆道并发症患者23例,包括胆漏患者12例,计胆管吻合口漏7例,肝断面胆管漏3例,胆囊管漏1例,迷走胆管漏1例;移植术后胆管狭窄患者11例,其中吻合口狭窄4例,非吻合口性狭窄7例.7例吻合口漏患者中,胆管重建2例(Roux-en-Y吻合和胆肠襻式Warren吻合);胆道吻合口修补1例;单纯依靠外引流管引流1例,活体双供肝肝移植的患者剖腹探查纠正胆漏失败后行再次肝移植1例;行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)植入支架2例.肝断面胆管漏3例中,行肝断面胆管缝扎1例,ERCP联合B超引导下穿刺引流2例,引流2个月后胆漏闭合,拔除引流管,但是随后又出现胆道狭窄,ERCP术后,病情好转.胆囊管漏1例,行胆囊管缝扎.迷走胆管漏1例,行胆囊床缝扎.吻合口狭窄的患者4例,3例经ERCP治愈,1例行胆肠吻合重建胆道后治愈.非吻合口性狭窄的7例,行ERCP治疗3例,ERCP失败后,行经皮肝穿刺胆管引流(percutaneous transhepatic cholangiographic drainage,PTCD)1例;再次肝移植3例,2例患者术后恢复良好,1例死于严重感染.结论 肝移植术后胆道并发症危害大,关键在于预防.

The diagnosis and treatment of biliary complications in liver transplant patients

Objective To investigate the treatment of biliary complications in perioperative stage of live transplantation. Methods From January 2007 to December 2009, 23 patients suffered from surgical biliary complications after liver transplantation. The clinical data including the types of biliary leakage,treatment, prognosis were analyzed retrospectively. Results Of 12 biliary leakage patients, 7 were anastomotic leakage, 3 with leakage of bile duct on the cutting surface of the graft of living ralated liver transplation, 1 with cystic duct leakage and 1 with leakage of aberrant biliary duct. Of 11 biliary stricture patients, 4 patients were anastomotic stenosis and 7 patients were no-anastomotic stenosis. The anastomotic biliary leakage of 7 patients was cured with biliary tract reconstruction in 2 patients, with cholangioenterostomy in 2 patients, with biliary reparation in 1 patient and peritoneal drainage in 1 patient but the patient with dual graft received re-transplantation. Three patients with biliary leakage on liver cut surface respectively receiving reparation or drainage were cured, of which 1 patient suffered from bile duct stricture and was finally cured by ERCP. One patient with biliary leakage of aberrant bile duct and 1 with biliary leakage of cystic duct were cured by salvage surgery. For the 4 patients with anastomotic stenosis, 3 patients were cured by ERCP and 1 patient recovered by biliary reconstruction. Among the patients with nonanastomotic stenosis, 3 cases were alleviated by ERCP or PTCD, another 3 patients had to receive retransplantation, of which 2 patients recovered well without surgery-related complications, one died of severe infection. Conclusions Biliary complications are common among liver transplant patients often causing significant mortality and morbidity necessitating comprehensive salvage procedures, though most of them are preventable.