肝胆管结石病肝移植(附4例报告)

目的 探讨肝胆管结石终末期病变肝移植的适应证及术中技术和围手术期处理的改进方法。方法 回顾性分析我科近年来施行的肝胆管结石终末期病变肝移植4例。结果 3例均为肝胆管结石继发胆汁性肝硬化失代偿期。病例1行先转流后游离肝脏的原位肝移植，病例2、3行不转流的改良背驮式肝移植，病例4行不转流的原位肝移植。平均手术时间7．9h，失血800ml。4例手术均成功。病例1术后第6天出现消化道出血，经保守治疗痊愈；病例2术后第44天并发消化道出血和胆肠吻合口漏，经治疗痊愈；病例4术后第8天和第10天并发肝动脉吻合口出血，经再次手术治疗，痊愈出院。术后病理结果为胆汁性肝硬化。所有病例均随访，健康存活。结论 肝胆管结石继发胆汁性肝硬化失代偿期是肝移植适应证。先转流后游离肝脏及改良背驮式肝移植技术的应用可以减少术中出血、降低术后并发症。

Liver transplantation for late-stage hepatolithiasis: a report of 4 cases

Objective To investigate the indication of liver transplantation for late-stage hepatolithiasis and improve the surgical technique. Methods The clinical data of 4 patients with late-stage hepatolithiasis treated with liver transplantation in our hospital in recent years were retrospectively analyzed. Results All the 4 patients suffered from late-stage hepatolithiasis. During operation, 1 patient underwent orthotopic liver transplantation by using veno venous bypass prior to the mobilization of llver, 2 the improved piggyback liver transplantation without bypass and 1 liver transplantation without the veno-venous bypass. All the 4 patients recovered after the transplantation. Postoperatively, case 1had digestive tract bleeding on day 6, cases 2 had hemorrhage from the digestive tract and a leakage of anastomosis between the bile duct and jejunum on day 44, and cases 4 needed reoperation because of hemorrhage from the liver arterial anastomosis on day 8 and 10. The mean duration of surgery was 7.9 h and blood loss 800 ml. Postoperative pathological analysis revealed biliary liver cirrhosis. All the 4 patients were followed up to the present and they had good life quality. Conclusions Hepatolithiasis with secondary biliary liver cirrhosis in end stage can be considered as one of the indications of liver transplantation. Veno-venous bypass prior to the mobilization of liver and the improved piggyback liver transplantation can decrease volume of intraoperative bleeding and morbidity of postopentive complications.