原位肝移植术后胆管并发症的预防与处理

目的 探讨原位肝移植术后胆管并发症的原因及防治。方法 2000年5月至2002年1月38例原位肝移植的临床资料进行回顾性研究。结果 本组38例病人术后共发生胆管并发症9例（9/38，24%）。其中单纯胆瘘4例，胆管空肠吻合口狭窄，肝内胆管结石，胆管狭窄合并胆泥形成，胆瘘继发胆管狭窄，胆管狭窄合并肝内胆汁瘤各1例。此9例中2例死于严重感染，7例痊愈。结论 原位肝移植术后胆管并发症病因复杂，后果严重。首先应该注重预防，并做到早期诊断。逆行性胰胆管造影术（endoscopic retrograde cholangiopanreatography,ERCP）和经皮经肝胆管造影术（percutaneous tran-shepatic cholangiography,PTC）等辅助性介入治疗手段应受到重视。

Management of biliary complications after orthotopic liver transplantation

Objective To study the causes and management of biliary complications after orthotopic liver transplantation.MethodsClinical data of 38 patients who have underwent orthotopic liver transplantation between May 2000 and January 2002 were studied retrospectively. ResultsPostoperative bililary complications occurred in 9 patients(24%), including simple biliary fistula in 4, stricture of hepatoenterostomy, intrahepatic cholelith, biliary stricture with sludge, biliary stricture with cholelith, and intrahepatic biloma and cholelith in one each. Two patients died of the complication, and seven were cured successfully. ConclusionsThe causes of biliary complications are complicated. Early diagnosis and timely management helps to decrease the mortality. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography is a valuable, less traumatic procedure.