胆道支架管在肝移植复杂胆道重建中的应用

The application of biliary stent for complex bile duct reconstruction in liver transplantation

目的探讨胆道支架管在肝移植复杂胆道重建中的应用及体会,提高胆道重建的技术。方法对2007年9月到2009年9月21例肝移植复杂胆道重建病例的临床资料进行分析。共行胆肠吻合5例(23.8%),胆肠Roux-en-Y吻合2例(9.5%),胆肠袢式Warren吻合3例(14.3%);肝肠吻合1例(4.8%);胆管端端吻合共15例(71.4%),其中胆总管端端吻合9例(42.9%),肝总管端端吻合3例(14.3%),右肝管端端吻合3例(14.3%)。胆道重建时间30～60 min。评价胆道重建的方式,胆道重建时间,术中胆道支架管的留置情况,术后并发症等资料。随访时间为术后3个月。结果胆道重建时,利用胆囊灌注管10例(47.6%);利用吻合口插管6例(28.6%);留置胆道支架管9例(42.9%),其中5例(23.8%)患者采用小儿胃管引流管,3例(14.3%)患者采用硬膜外导管,1例(4.8%)患者采用T管。术后有2例(9.5%)患者出现了胆道并发症,均为缺血性胆道并发症,其余患者术后肝功能及胆道情况良好。结论对于肝移植中复杂的胆道重建除娴熟的显微外科技术及恰当的重建方式外,要重视胆道支架管的合理应用。

Objective To discuss the application of biliary stent for the complex bile duct reconstruction in live transplantation.Methods From September 2007 to September 2009,there were 21 patients who received difficult bile duct reconstruction in liver transplantation.Among these 21 cases,5 patients(23.8%) received cholangioenterostomy,2(9.5%) received Roux-en-Y cholangioenterostomy,3(14.3%) of them received Warren;1(4.7%) patient received liver sausage anastomosis;15(71.4%) patients received duct to duct bile reconstruction,9 patients(42.9%) received common bile duct anastomosis,3 patients(14.3%) received hepatic duct anastomosis,three patients(14.3%) received right hepatic duct anastomosis.The reconstructions were spent between 30-60 min.We retrospectively analyzed the clinical data of them,the methods of operation,the time of bile duct reconstruction,the types of biliary stent,the biliary tract complication,and so on.Results During biliary reconstruction,the gallbladder perfusion tubes were used for 10 patients(47.6%),the anastomosis intubation was used for 6 patients(28.6%),the biliary stents were used for 9 patients(42.9%),5 patients(23.8%) were treated with gastric tube for children,3 patients(14.3%) were treated with epidural catheter and 1 patient(4.8%) was treated with T-tube.Two cases(9.5%) suffered from biliary complication after liver transplantation.Both of them were ischemia-type biliary lesion.The liver function and bile duct of the others were in good condition.Conclusions In addition to skilled microsurgery operation and suitable method,the biliary stent is safe and feasible in complex biliary reconstruction.