原位肝移植术后胆道并发症治疗经验

目的总结原位肝移植术后胆道并发症的治疗经验。方法1999年2月至2004年2月,我中心采用胆总管-胆总管端端吻合术施行原位肝移植236例,96例采用置“T”管引流的胆管间断吻合;39例采用未置“T”管的胆管间断吻合技术;101例采用未置“T”管、前壁间断后壁连续的胆管吻合。结果全组术后32例(13·3%)发生胆道并发症,其中胆管狭窄24例(10·0%),胆漏6例(2·5%),胆管结石2例(0·8%)。3组胆道并发症发生率分别为17·7%、15·4%和7·9%,其中肝门部/肝内胆管狭窄发生率分别为8·3%,2·6%和1·0%。第3组胆道并发症发生率和胆管狭窄发生率显著降低(P<0·05)。20例胆管狭窄患者接受放射和/或内镜介入治疗,其中单纯吻合口狭窄治愈率90%,肝门部/肝内胆管狭窄治愈率60%。结论弃用“T”管的胆管前壁间断后壁连续的吻合方式能显著减少胆道并发症;非缺血相关性胆管吻合口狭窄和单纯肝门部胆管狭窄应首选介入治疗。

Management of biliary complications following orthotopic liver transplantation

Objective To evaluate the management of biliary complications (BC) following orthotopic liver transplantation (OLT). Methods From Feb 1999 to Feb 2004, 236 cases underwent OLT with end-to-end choledocho-choledochostomy. Biliary anastomosis was performed by intermittent suture with T tube placement in 96 cases, without T tube in 39 cases, by continuous suture in posterior wall and intermittent suture in anterior wall and without T tube in 101 cases. Results Thirty-two (13.3%) patients developed BC, with incidences in group 1, 2 and 3 of 17.7%, 15.4% and 7.9%, respectively. The incidence of hepatic hilar and/or intrahepatic bile duct strictures was 8.3%, 2.6% and 1.0%, respectively. BC incidence in group 3 significantly decreased. Twenty patients with biliary stricture underwent endoscopic and/or radiological interventions, and stricture resolution was achieved in 90% of patients with anastomotic strictures and 60% of patients with hepatic hilar and/or intrahepatic strictures. Conclusions Modified biliary tract reconstruction technique contributes to the decrease of BC. Endoscopic and/or radiological interventions should be used for non-ischemic anastomotic biliary strictures or simple hepatic hilar strictures.