24例不置T管胆总管对端吻合式肝移植术后胆道并发症的病因分析

目的通过观察不置T管胆总管对端吻合式（choledocholedochostomy without a T tube，CC）肝移植术的临床疗效，探讨新的胆管对端吻合法及胆道并发症的病因。方法回顾分析我院24例CC的肝移植患者临床资料，并对其中4例胆道并发症的病因进行探讨。结果经手术或磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP）等检查确诊胆道并发症4例（占16．7％），其中术后早期肝内外胆管坏死伴胆瘘2例，均死亡；术后早期一过性胆瘘2例，其中1例又出现晚期肝门部胆管狭窄，均治愈。结论CC在肝移植的应用是安全可靠的。供体术前肝素化不充分导致胆管小分支微血栓形成，供肝胆道冲洗不彻底、冷热缺血时间过长、胆管保留过长及胆道供血系统破坏等均可引起胆管损伤，增加胆道并发症的发生率。

Etiological analysis of the postoperative complication of end-to-end choledochocholedochostomy without a T tube in orthotopic liver transplantation

Objective To evaluate the curative effect of the choledocholedochostomy without a T tube (CC) and cause of the complications of the biliary tract in orthotopic liver transplantation(OLT).Methods From December 2002 to December 2004,the clinical data of 24 cases subjected to OLT with CC in our hospital were analyzed restrospectively.The causes of the complications of 4 cases's biliary tract among them were investigated.Results All complications of the biliary tract made a definite diagnosis through operations or MRCP.Among them,2 cases subjected the liver exterior and interior biliary ducts necrosis with biliary fistula postoperative nonage both died.2 cases subjected the transient biliary fistula postoperative nonage were cured,meanwhile one of them subjected the stenosis of bile duct in hepatic portal with stone in advanced stage was cured.Conclusion CC is safe and reliable in OLT.Insufficient heparinizing for donor before operation will induce micro-thrombogenesis in blood vessel rami of the bile duct.There were several causes to induce the damage of the bile duct,such as the biliary tract of donor's liver not been washed thoroughly,the time of cold-warm ischemia being excess,the biliary tract of donor reserved excessly,the blood-supply of the biliary tract destroied.They all increase the incidence rate of the complication of biliary tract.