肝移植术后胆道并发症的防治

目的 探讨原位肝移植术后胆道并发症的预防与治疗.方法 对1995年5月至2006年12月中国医科大学附属第一医院183例肝移植患者术后胆道并发症的发生情况进行回顾性分析.结果 共发生胆道并发症15例,发生率为8.2%,其中近期并发症占6.0%(11例),远期并发症占2.2%(4例),未发生与肝动脉血栓形成有关的胆道并发症.15例中13例治愈,其中4例行经皮肝穿胆道造影(PTC)并留置支架管,8例行内镜逆行胰胆管造影(ERCP)并进行胆道冲洗及留置支架管,1例吻合口狭窄患者在外院行ERCP未成功而改行胆管空肠吻合术,均获治愈.2例因近期发生胆汁漏而行胆管-空肠Roux-en-Y吻合者最后均死于真菌感染,胆道并发症相关死亡率为1.1%.结论 采用腹腔器官联合快速切取技术可缩短供肝冷、热缺血时间,防止变异胆管和血管损伤,降低胆道并发症.肝移植术中注意保护胆总管的血运是减少胆道并发症的关键.PTC和ERCP结合留置支架管是非缺血型胆道并发症的主要治疗手段.

Prevention and treatment of biliary complications following orthotopic liver transplantation

Objective To study the prevention and treatment of biliary complications after orthotopic liver transplantation.Methods Clinical data of 183 recipients who had received liver transplantation between May 1995 and December 2006 were retrospectively analyzed.Rseults Biliary complications occurred in 15 patients(15/183,8.2%).The incidence for short-term and long-term complication were 6.0%(11/183)and 2.2%(4/183)respectively.No biliary complications was due to hepatic artery thrombosis(HAT).Four cases who received PTC(percutaneous transhepatic cholangiography)with stent insertion,8 cases who received ERCP(endoscopic retrograde cholangiopancreatography)with stent insertion and 1 who received Roux-en-Y choledochojejunostomy for anastomotic stricture were successfully cured.Two cases required relapretomy died for infungus infection eventually.The mortality due to biliary complications was 1.1%.Conclusions The rapid combined abdominal organ harvesting technique could shorten the ischemia time and ameliorate the injury due to vascular and bile duct variances,which could reduce the incidence of biliary complication.PTC and(or)ERCP combined with stent insertion were main procedure for biliary complications not related to HAT after liver transplantation.