胆道系统疾病的肝脏移植治疗

Liver Transplantation for Biliary Tract Disease

胆道系统疾病始终是选择肝脏移植治疗的诸多病种中的一个重要适应证,其在病例选择及适应证方面主要包括:先天性胆道闭锁、易恶变的胆道疾病、胆道恶性肿瘤、原发性胆汁性肝硬化和继发性胆汁性肝硬化等病变,且这些疾病各有其适应证。胆道系统疾病行肝脏移植手术的时机包括:当肝脏移植为疾病治疗的唯一手段或唯一有效手段时;肝脏移植为疾病外科治疗的方法之一时。虽然国内外目前尚无一个统一标准用于胆道疾病行肝脏移植术前的评估,但首先应是明确诊断;其次要确定胆道疾病患者目前是否急需行肝脏移植以及急需的程度;再者要患者家属了解肝脏移植的整个过程,知道其存在的危险、移植的价值以及术后终身服用免疫抑制剂等。本文通过笔者的经验和实例分析胆道系统疾病肝脏移植手术的相关问题。

Biliary tract diseases have always been one of the important indications for liver transplantation. These biliary tract diseases include congenital atresia of biliary duct, biliary diseases with tendency of malignant transformation, malignant biliary diseases, primary biliary cirrhosis, and secondary biliary cirrhosis. The right time to consider liver transplantation for the above biliary diseases includes situations when transplantation is the only approach to treat the disease, the only effective approach to treat the disease, or one of the effective approaches to treat the disease. Currently there is still no commonly accepted pre-operative evaluation standard for biliary disease-related liver transplantation. However, it is important to obey the following principles. First, the diagnosis should be confirmed; secondary, the necessity or urgency of the liver transplantation should be clarified; and third, the patient and his/her family should understand the whole procedure of transplantation the risk and advantage of the surgery, and the potential life-long intake of immunosuppressors. This article will briefly review all these relavant issues based on the authors＇ personal experience and clinical cases.