肝移植术后早期胆道并发症65例诊治体会

目的探讨肝移植术后早期胆道并发症的诊断和治疗。方法回顾性分析了我院2006年5月～2008年3月以来成功实施的65例肝移植的临床资料。其中尸肝移植54例，亲体肝移植11例，女性占16．92％（11／65），男性占83．08％（54／65）。结果本组65例肝移植患者其中有8例3个月内出现胆道早期并发症，发生率为12．31％（8／65），分别为胆漏3例，胆汁瘤1例，肝内胆汁湖1例，胆泥形成1例，胆道狭窄2例。女性患者早期胆道并发症发生率为9．09％（1／11），男性患者早期胆道并发症发生率为12．96％（7／54）。8例患者中，留置T管引流1例，未留置T管引流7例。治愈6例，好转2例，死亡0例（0％）。其中3例术后3d内出现单纯胆漏，通过留置的腹腔引流管得到及时的诊断，同时应用留置的腹腔引流管持续引流4周～2月后得到治愈。5例经B超、MRCP、ERCP得到诊断；1例胆汁瘤和1例肝内胆汁湖通过B超引导下穿刺引流而得到治愈；1例胆泥形成通过ERCP进行胆道冲洗后好转出院；2例通过ERCP进行球囊扩张或者放置支架后好转出院。结论肝移植术后早期胆道并发症的诊断主要手段是留置的腹腔引流管、B超、MRCP、ERCP等：肝移植术中留置的腹腔引流管对于肝移植术后早期胆漏的治疗起着特殊的作用：B超引导下穿刺引流是治疗胆汁瘤、胆汁湖的重要手段；ERCP下胆道冲洗对胆泥形成非常有效．ERCP下球囊扩张或者放置胆道支架对胆道狭窄的治疗很有效。

Diagnosis and management of early biliary tract complications after liver transplantation：a report of 65 cases

Objective To explore diagnosis and treatment of early biliary tract complications after orthotopic liver transplantation. Methods The clinical data of 65 patients who underwent orthotopie liver transplantation between May in 2006 and March in 2008 were studied retrospectively, which there were 54 patients underwent cadaver liver transplantation, wheas 11 patients unerwent living donor liver transplantation, 54 of 65 cases were male（83.08%）, the residue was female（16.92%）. Results There were 8 cases occurred biliary complication in this term （65 cases）. The occurrence of biliary complications was confirmed by abdominal cavity drainage tubes, B ultrasonography , MRCP and ERCP in eight cases, which were respectively bile leakage （n=3） , biloma （n=1）, intra- hepatic bile lake（n=1）, biliary sludge（n=1）, biliary tract stenosis（n-2）; The morbidity related to female was 9.09% （1/11）, however, it was 12.96%（7/54） relating to male. Only one of eight patients received T tube for drainage , Six of them was cured, two turned better and no one died. 3 cases of them occurred simplex biliary leak in the 3rd day and resolved it by drainage for 4 weeds to 2 monthes with abdomental cavity drainage tube. Patients who underwent biloma or intrahepatic bile lake were cured through pricking by guide of B ultrasonic; only one patient who underwent biliary sludge discharged after obvious improving by bile duct douching; two patients who underwent biliary tract stenosis were managed by balloon dilatation or bile tract plastic stent placement. Conclusion The important methods for early biliary tract complications after orthotopie liver transplantation are abdominal cavity drainage tubes, B ultrasonography , MRCP and ERCP. abdominal cavity drainage tubes is beneficial to diagnose and treat biliary leak ; pricking by guide of B ultrasonic is important for biloma or intra- hepatic bile lake; ERCP is very effective and important method for management of biliary sludge and biliary tract stenosis.