肝移植术后胆道并发症的预防

目的　探讨如何预防肝移植术后胆道并发症的发生。方法　对 1993年 4月至 2 0 0 1年10月我科实施的 12 0例肝移植病人临床资料进行回顾性分析。结果　共有 10例病人通过胆道造影确诊为肝移植术后胆道并发症 ,8例治愈 ,1例好转 ,1例死亡。胆道并发症发生率为 8 3 % (10 / 12 0 ) ,与胆道并发症相关的死亡率为 0 8% ,与T管相关的胆道并发症发生率为 4 3 % (5 / 116) ,与肝动脉供血相关的胆道并发症发生率为 1 7% (2 / 12 0 )。热缺血时间 >3min、冷缺血时间 >8h组胆道并发症发生率明显升高 (P <0 0 5 )。结论　胆道保存性损伤是引起肝移植术后胆道并发症的重要原因。缩短供肝的热、冷缺血时间和确保供肝胆管系统的血供可减少胆道并发症的发生。改进T管置管方法可显著降低与T管相关的胆道并发症发生率

Prevention of biliary complications after liver transplantation

Objective To explore prevention of biliary complications after liver transplantation. Methods The clinical data of 120 patients receiving liver transplantation in our department between April 1993 and October 2001 were retrospectively analyzed. Results The occurrence of biliary complications was confirmed by cholangiography in 10 cases. Eight of them was cured, 1 turned better and 1 died. The morbidity was 8 3% (10/120) and the mortality related to biliary complications was 0 8% (1/120). The incidence of biliary complications related to hepatic artery was 1 7% (2/120) and that related to T tube was 4 3% (5/116). The incidence of biliary complications was significantly increased in the group of WIT>3min and CIT>8hrs. Conclusions Biliary injury is an important reason for biliary complications after liver transplantation. Reducing the ischemic time of donor liver and avoiding the damage of blood supply system of donor liver bile duct can decrease the morbidity of biliary complications. Improvement of operative skills effectively decrease the incidence of biliary complications related to T tube.