肝移植术后胆道并发症发生原因及预防

Etiology and Prevention of Biliary Tract Complications

目的:探讨同种异体原位肝移植术后胆道并发症发生的原因及预防措施.方法:回顾性分析我院1999年6月至2005年2月完成的50例同种异体原位肝移植.经典式肝移植4例,改良背驮式肝移植45例,其中包括2例肝肾联合移植,部分亲体肝移植1例.50例中经门静脉、下腔静脉转流下原位肝移植22例,无转流28例.胆道重建:胆管对端吻合49例,其中28例置'T'管外引流,21例未置'T'管引流.胆肠吻合1例.结果:共有7例发生胆系并发症,2例为术后近期经腹腔引流管少量胆漏,1周左右停止.2例为术后远期(1～3月)因发热再次入院经影像学证实为胆管吻合漏,肝门区包裹性积液形成.3例手术后1～3月 内发生肝内胆管狭窄并淤泥形成.结论:供体胆道即时充分的灌洗,移植物冷热缺血的时间不宜过长及良好的胆道吻合技术和确保胆道血供,是预防肝移植术后胆道并发症的关键.

Objective: To approach the etiology and preventive measures of biliary tract complications after liver allograft. Methods: 50 inpatients after liver allograft in situ from June 1999 to February 2005 were analyzed retrospectively. 4 cases of all were performed by classical way; 45 cases by modified piggyback way, including 2 cases of liver-kidney combined transplantation and 1 case of living related partial liver transplantation. 22 cases of liver transplantation through inferior vena cava bypass, 28 cases through no bypass. For biliary tract remodeling, 49 cases with both terminals' anostomosis of bile duct, including 28 cases with T-tube drainage, 21 cases without T-tube drainage, 1 case with portoenterostomy. Results: Biliary complications occurred in 7 cases, of which 2 cases with little amount of postoperative bile leakage out of peritoneal which disappeared after a week. 2 cases with bile duct anostomosis leakage bringing about pelvic encapsulated fluid in hepatic portal area as a long-term outcomes after operation, and 3 cases with in-hepatic bile duct stenosis and formed biliary sludge. Conclusion: Immediate and throughout irrigation of bile ducts of donors, grafter's ischemia under cool and head conditions controlled within a short period, biliary anostomosis well operated and blood supply in biliary tract ensured are the keys for prevention from biliary tract complications after liver transplantation.