肝泡球蚴病肝移植胆道并发症诊治的初步体会

Initial observation of bile duct complications after liver transplantation for hepatic alveolar echinococcosis

目的:探讨泡球蚴病(hepatic alveolar echinococcosis,HAE)肝移植胆道并发症的诊断和处理。方法: 快速肝、肾联合切取供肝,其热缺血时间控制在6 min内。2例肝泡球蚴病患者分别采用“经典式”和“背驮式”原位肝移植,并行空肠肝总管Roux-en-y吻合术,观察2例治疗效果。结果:2例患者肝移植后1-3周左右出现胆汁性状改变,量少、色淡、稀薄。2个月左右形成“胆泥树”,分别于移植后45 d和4个月,因胆道反复感染导致感染性休克和肝、肾功能衰竭死亡。结论:(1)肝泡球蚴病呈“类癌”样浸润性生长,可直接侵犯胆道内皮细胞,其本身的液化坏死物堵塞胆道造成胆道高压,与胆道的感染互为因果。(2)肝泡球蚴病肝移植因其早期侵犯胆道及高胆道并发症,放置“T”型管具有必要性。(3)泡球蚴病感染可产生一定程度的免疫耐受现象。应注意该类患者肝移植后的免疫抑制药物剂量的选择。

Objective： Initial observation of bile tract complications after liver transplantation for hepatic alveolar echinococcosis（HAE）. Methods. Two HAE cases were performed orthotopic liver transplantations. Result： Both of them presented the bile duct infection, bile mud deposited in the bile tract, and endodermis were destroyed. Conclusion： （1）HAE can directly destroy the bile duct, its putrescence blocks the bile duct, and high pressure in the duct. Infection is easy to occur. （2） T-tube is necessary in HAE transplant, because of the high rate of bile duct complications. （3） Animal experiments show that E. m infected animals could have more tolerance to immuno-suppression. It still need more clinical study.