原位肝移植术后缺血型胆道病变20例

目的探讨原位肝移植术后缺血型胆道病变（ITBL）的病因及预防、诊断和治疗的措施。方法回顾性分析1999年2月至2005年4月间291例次原位肝移植后发生ITBL患者的临床资料。结果291例次原位肝移植术后共发生ITBL 20例（6．9％）。术后发生ITBL的高危因素为：原发病为重型乙型肝炎、供受者ABO血型不符、供肝冷保存时间超过12h和术后肝动脉病变。其发生率分别为12．5％（9／71）、20．0％（2／10）、11．1％（9／81）和60％（3／5）。采用药物、经内镜逆行胰胆管造影（ERCP）介入、胆道外科手术及再次肝移植等方法治疗，有效率为80．0％（16／20）、治愈率为50．0％（10／20），与ITBL相关的病死率为10．0％（2／20），与ITBL相关的移植物功能丧失发生率为20．0％（4／20）。结论针对ITBL的高危因素进行相应处理是预防ITBL的有效措施。胆道造影和核磁共振胆胰管成像对诊断ITBL有很高的敏感性和特异性。根据不同的病因和病变程度采用适当的方法治疗ITBL，可获得良好的疗效。

Prophylaxis and management of ischemic-type biliary lesion after orthotopic liver transplantation

Objective To discuss the prophylaxis and management for ischemic-type biliary lesion (ITBL) after orthotopic liver transplantation.Methods Clinical data of 291 patients who underwent orthotopic liver transplantation between February 1999 and April 2005 were retrospectively reviewed.Results Among the 291 patients, 20 (6.9 %) patients developed ITBL. The development of ITBL was statistically significantly associated with the duration of cold ischemic storage of allografts (more than 12 h), the use of ABO incompatible grafts, postoperative hepatic arterial occlusion, and pretransplantation HBV-related fulminant or subacute hepatic failure. The incident of ITBL in those recipients was 11.1 % (9/81), 20.0 % (2/10), 60 % (3/5) and 12.5 % (9/71) respectively. The patients were treated with drugs, ERCP, operation and retransplantation. 50.0 % (10/20) of the patients was cured. The mortality was 10 % (2/20). The incidence of graft loss was 20 % (4/20).Conclusions To prevent ITBL, it is crucial to avoid too long time of cold ischemic storage of allografts, the use of ABO incompatible grafts and reduce postoperative hepatic arterial occlusion. Cholangiography and MRCP are main measures for diagnosis of ITBL. Management should be taken according to different types and causes of ITBL.