172例肝移植术后不同类型胆道并发症回顾性分析

目的探讨肝移植术后不同胆道并发症的临床特点及危险因素。方法回顾性分析本院2004年8月至2010年3月施行的172例肝移植患者的临床资料。对围手术期45个变量进行单因素分析,筛选肝移植术后各种类型胆道并发症的危险因素。结果 32例发生胆道并发症,患病率为18.6%。其中单纯类型21例,复合类型11例。总计发生胆漏10例(31.25%),胆管吻合口狭窄7例(21.88%),非吻合口胆管狭窄12例(37.50%),胆道结石11例(34.37%),胆道感染10例(31.25%),胆道出血2例(6.25%)。大部分临床类型之间均存在着明显关联性,以胆道结石与胆道感染的关联最为密切(列联系数C=0.478,P<0.01)。早期胆道并发症中所占比例最多者为胆漏者(52.90%),晚期胆道并发症中所占比例最多者为胆道结石/胆泥(46.70%)及胆道感染(46.70%)。单因素分析显示,肝动脉阻力指数(RI)的降低、急慢性排斥反应、T管留置、无肝期延长、术前高总胆红素血症及其所致的Child Pugh评分和MELD评分升高均可能与不同类型并发症相关,而改良的胆道缝合方式、国际标准化比值(INR)的升高可能是某些类型并发症的保护因素。结论肝移植术后胆道并发症不同类型之间大多存在明显关联性,胆漏大都发生在早期,胆道结石及感染则大多发生在晚期,胆管狭窄则在早期、晚期均可能发生,许多因素可能与不同类型胆道并发症相关联,严密监测肝动脉血流、改进手术技巧、缩短无肝期、弃用T管、保护胆道血供、规范的抗排斥治疗可能有助于降低胆道并发症发生率。

Different types of biliary complication after liver transplantation: A retrospective analysis of 172 cases

Objective To study the clinical characteristics of and the risk factors for different types of biliary complication(BC) after liver transplantation.Methods Clinical data about 172 patients who underwent liver transplantation from August 2004 to March 2010 in our hospital were retrospectively analyzed.Univariate analysis of 45 variables during peri-operation was performed to screen the risk factors for different types of BC after liver transplantation.Results BC occurred in 32 cases(21 cases of simple type and 11 cases of complex type) with a BC rate of 18.6%.Biliary leakage,anastomotic biliary stricture(ABS),non-anastomotic biliary stricture(NABS),and biliary calculi,infection and hemorrhage occurred in 10(31.25%),7(21.88%),12(37.50%),11(34.37%),10(31.25%),and 2(6.25%) cases,respectively.Significant correlations were observed between most types of BC,especially between biliary calculi and infection(C=0.478,P<0.01).The proportion of biliary leakage in patients with early BC and that of biliary calculi and infection in patients with late BC were the highest,accounting for 52.90%,46.70% and 46.70%,respectively.Univariate analysis showed that the lower hepatic artery resistive index(RI),acute and chronic rejection reaction,T-tube indwelling,longer anhepatic phase,preoperative hyperbilirubinemia with a high Child-Pugh score and MELD score might be related with the different types of BC.Modified suture method and increased international normalized ration(INR) might the protective factors for certain types of BC.Conclusion There is a significant relation among different types of BC after liver transplantation.Most biliary leakages occur in the early period while most biliary calculi and infection occur in the late period.Biliary stricture may occur both in early and late periods.Many factors are related with different types of BC.Close monitoring of hepatic arterial flow,improving surgery techniques,shortening anhepatic time,no use of T-tube,protection of biliary blood supply,and standard anti-rejection therapy may help to reduce the incidence of BC after liver transplantation.