改进供肝处理方法减少肝移植术后早期胆道并发症

目的改进供肝处理方法，以减少肝移植术后的胆道并发症。方法供肝处理进行如下改进：（1）肝门游离仅达胃十二指肠动脉下缘，不游离其上方的肝蒂结构；（2）修整供肝时暂不结扎胃十二指肠动脉本身的断端；（3）修整供肝时暂不切除胆囊，待供肝植入、肝动脉重建后切除。共行99例肝移植，患者的原发病，58％为良性肝病，42％为肝癌。供肝热缺血和冷缺血时间分别控制在5min和16h以内。胆道重建方式均为胆总管-胆总管端端吻合，其中5例放置T管。观察术后早期胆道并发症的发生情况。结果4例（4％，4／99）肝移植术后发生胆道并发症，其中1例术后10d发现胆道吻合口漏；1例术后5个月胆道内有胆树形成；1例为胆道吻合口狭窄；1例为左肝管狭窄。改进前的肝移植术后早期胆道并发症发生率为11．6％（5／43）。结论通过改进供肝的处理方法，可最大限度地保留供肝胆道血液供应，显著减少术后胆道并发症。

Improved liver donor treatment reduced biliary complications after liver transplantation

Objective To explore the causes of biliary complications related with liver donor following liver transplantation. Methods Ninty-nine patients with improved liver donor treatment during liver transplantation from May 2005 to April 2006 were followed up and the clinical data were analyzed. At the same time, the rate of biliary complications was compared with that occurring on 43 patients with unimproved liver donor treatment. Results Only 4 in 99 patients with improved liver donor treatment had biliary leakage with the rate of biliary complications being 4% in comparison with 11% in those with unimproved liver donor treatment. Conclusion The improvement of liver donor treatment,including shortening heat-ischemia time, completely washing bile duct and remaining the whole blood supply of bile duct, can decline the occurrence of biliary complications.