原位肝脏移植术后早期胆道并发症诊断与治疗

目的探讨原位肝移植术后胆道并发症的发生原因及防治措施。方法回顾性研究2002年7月-2005年1月该组肝脏移植32例原位肝移植的临床资料。结果该组32例肝脏移植受体中有6例发生胆道并发症，其中3例术后3d内出现单纯胆漏，给予小号导管置入T管周边引流，均在8d后未见胆漏。1例经影像学诊断肝动脉吻合口狭窄经介入置入支架扩张后，胆道并发症好转，肝功能恢复。1例术后1周出现霉菌感染，给予相应治疗，因出现肝昏迷多脏器功能衰竭死亡。1例术后第3天出现无胆汁，B超示肝内外胆管扩张，行T管造影术。发现T管胆管内的上支行成活瓣，随在介入下置入超滑导丝效果欠佳，第2天在超滑导丝的基础上置入4F管，引流通畅，肝功能快速恢复。结论手术技术不佳、移植物冷热缺血的时间不宜过长及胆管的血液供应不良是肝移植术后发生胆道少并发症的重要因素，联合应用胆道造影术和核磁共振胆管成像能了解胆道今新．有助干胆省犊窑与胆漏的论断．及时采用放射介入技术处理胆道并发症可取得良好疗效。

Diagnosis and management of biliary tract complications after liver transplantation

Objective] To discuss the cause and management of biliary tract complications after orthotopic liver transplantation. Methods] Clinical data of 32 patients who underwent orthotopic liver transplantation between July, 2002 and Jan, 2005 were studied retrospectively. Result] There were 6 cases occurred biliary complication in this term (32 cases). 3 cases of them occurred simplex biliary leak in the 3rd day and resolved it by drainage with small size tube around the T tube after 8 days. 1 case occurred anastomotic stricture of liver arteries diagnosed by imageology resolved by placed the bracket through the intervention, and then the function of the liver was comebacked. One week after transplantation 1 case occurred mildew infection was died after corresponding treatment because of the liver exanimation and multiple system organ failure (MSOF). At day 3 after transplantation 1 case lacked gall, after ultrasonic diagnoses it was biliary dilatation in or out of the liver and after T tube imaging there formed a valve of the biliary above the T tube. The effect was not good after placed extraordinary slippery leads through the intervention and resolved it by adding the 4F tube based on extraordinary slippery leads. The function of the liver was comebacked quickly. Conclusions] The important factors for biliary tract complications after liver transplantation are immature technique for operation, lacking blood long to the implants and lacking plenty blood supply to the biliaries. Distributing of the biliaries will be realized by biliary imaging and MRI and it is beneficial to diagnose biliary leak and biliary stricture. The treatment of biliary tract complication by intervention is effective.