肝移植术后胆道并发症及其处理(附150例次报道)

Biliary complications following orthotopic liver transplantation and its management (Report of 150 cases)

目的 对肝移植术后胆道并发症的病因、诊断、治疗进行探讨。方法 回顾分析 2 0 0 1年 4月～2 0 0 4年 6月我科施行的 15 0例次 (共 14 7例 )肝移植患者的临床资料 ,对 35例次胆道并发症患者进行病因分析 ,并结合文献讨论。结果 有 12例次患者 (34.2 % )出现早期并发症 ,2 3例次患者 (6 5 .8% )出现迟发性并发症。其中吻合口狭窄 13例次 (37.1% ) ,由于排异、肝动脉血栓形成、巨细胞病毒 (CMV)感染、化疗等原因造成肝内、外胆管多发狭窄和坏死分别为 2、6、1、2例次 (5 .7%、17.1%、2 .9%、5 .7% ) ,吻合口胆漏 7例次 (2 0 .0 % ) ,拔除T管后发生胆漏 3例次 (8.7% ) ,由于Oddi’s括约肌失调致胆管炎、胆管结石 1例次 (2 .9% )。结论 肝移植术后胆道并发症发生的病因机制仍有许多方面值得研究探讨 ,及时预防、诊断。

Objective To investigate the pathogenesis,diagnosis and treatment of biliary complications following orthotopic liver transplantation.Methods Among 150 OLTs, 35 patients were diagnosed of biliary complications from Apri 2001 to Jun 2004.The clinical data were analysed retrospectively and the causes of biliary complication were discussed with some related literatures.Results There were 12(34.2%) early complications and 23(65.8%%) later complications; including 13(37.5%) with anastomosis strictures, intra- and extra- hepatic multiple biliary strictures and rejection necrosis, hepatic artery thrombosis ,cytomagelovirus infection, and chemotherapy were found in 2,6,1,2(5.7%,17.1%,2.9%,5.7%) patients, respectively. 7(20.0%)had anastomosis bile leakage and 3(8.7%) bile leakage after T tube removed. One(2.9%) patient suffered from cholangitis and cholothiasis caused by Oddi's sphincter dysfunction. Conclusions There are many aspects worth while to be investigated for the pathogenesis of biliary complications following orthotopic liver transplantation. Proper prevention, timely diagnosis and treatment will improve patients' quality of life and life span greatly. (Shanghai Med J, 2004,27∶808-810)