活体肝移植的胆道重建技术及并发症分析

目的 探讨活体肝移植的胆道重建方法及并发症防治措施.方法 回顾性分析77例活体肝移植临床资料,其中74例行右半肝移植(带肝中静脉29例,不带肝中静脉45例),左半肝带肝中静脉1例,左外叶切取2例.胆道重建采用胆肠吻合或供肝肝管与受体肝管端端吻合.结果 供肝断面1个胆管开口为54例,多个胆管开口为23例;胆肠吻合2例,胆管端端吻合75例,63例留置T管;术后总体胆道并发症发生率为36.4%(28/77),其中胆漏为10.4%(8/77),胆道狭窄为26.0%(20/77).供肝单支胆道以及单个吻合口术后胆道狭窄的发生率明显低于多支胆道及多个吻合口(P<0.05).8例胆漏病人经过B超指引穿刺引流全部治愈,20例吻合口狭窄病人经T管窦道放置支撑管或通过ERCP进行扩张,肝功能全部或部分好转.结论 活体肝移植供肝切取术中注意对断面胆管血供的保护以及尽可能获得单一的肝管开口可有效减少术后胆道并发症的发生;内镜和放射介入技术是治疗胆道并发症的有效手段.

Biliary reconstruction and complications of living donor liver transplantation

Objective To describe the feasibility of biliary reconstruction methods and to explore the preventing and curing methods for biliary complications. Methods A total of 77 cases of living donor liver transplantation were included in our study for retrospective analysis. The operation types included right lobe contain middle hepatic vein (n=29), right lobe without middle hepatic vein (n=45), left lobe (n=1) and left lateral lobe transplantation (n=1). The biliary reconstruction was performed by duct-to-duct and Roux-en-Y epaticojejunostomy. Results Fifty-four grafts had 1 bile duct and 23 had multiple ones. The duct-to-duct biliary reconstruction was performed for 75 adult cases and T-tube drainage was used in 63 patients. Meanwhile, the conventional Roux-en-Y epaticojejunostomy was utilized for 2 pediatric patients. Total biliary complication incidence was 36.4% (28/77) and the complications included bile leakage (10.4%, 8/77) and biliary stricture (26.0%, 20/77).The rate of biliary complication was remarkably different between single hepatic duct group and multiple group (P<0.05). All the 8 patients suffering from bile leakage were cured by percutaneous bile drainage guided by ultrasound. By percutaneous balloon cholangioplasty and placing stent through the T-tube tract or endoscopic retrograde balloon cholangioplasty, the liver function of biliary stricture cases got better and most cases were cured. Conclusion Protecting the blood supply of bile duct at the cutting surface and harvesting one bile duct stump as much as possible can reduce biliary complication effectively. Radiate intervention treatment such as percutaneous balloon cholangioplasty and endoscope treatment etc. are effective for treatment of biliary complications.