肝移植术后胆道并发症的防治

目的：探讨肝移植术后胆道并发症的防治。方法：对7例终末期肝病（包括3例原发性肝癌）患者行原位肝移植，供肝除1例仅经门静脉灌注外，其余均经动脉及门静脉双重灌注。胆道重建采用胆道端端吻合6例，胆肠吻合1例。结果：3例出现胆道并发症，术后2w，发现1例T管周围胆漏，经放开T管后治愈；术后12d，1例出现胆漏，再次手术发现胆管从吻合口穿出，第2次术后腹腔感染一度控制，术后49d再次高热，术后52d死亡，尸检发现胆管坏死，胆漏，1例术后3d发生胆漏,昆充分引流治愈，术后4个月发现有胆泥，经口服溶石药等治疗，症状消失。结论：对供者动脉充分灌注，胆道充分冲洗，尽量减少对供者胆管血供的损害是预防胆道并发症的关键，而术后胆道并发症多经非手术或微创手术治愈。

Prevention and treatment of biliary complication following orthotopic liver transplantation

Objective To investigate the prevention and treatment of biliary complication following orthotopic liver transplantation (OLT).Methods OLT were performed on 7 patients with end stage liver disease (including 3 patients with primary liver cancer). Except 1 case was infused only through the portal vein, the other two were infused through both portal vein and hepatic artery in donor. The biliary tract was reconstructed using choledochocholedostomy anastomosis in 6 cases, and using Roux en Y choledochojejunostomy anastomosis in 1 case.Results Biliary complication occurred in 3 cases. In one case, at day 14 postoperatively, the biliary leak occurred around T tube and resolved after the T tube was re open; In one case of Roux en Y choledochojejunostomy anastomosis, the biliary leak occurred at day 12 postoperatively. Re operation found the T tube escaped from the anastomis. In one case the biliary leak occurred at day 3 postoperatively and resolved by delaying the removal time of drainage catheter.Conclusion In order to reduce the incidence of biliary complication, full infusion via the hepatic artery, complete slush to the biliary tract, and the reduction of injurying the blood supply of donor biliary tract are necessary. Most biliary complication can relieved by non operative treatmment or minimally invasive operation.