肝移植术后胆管并发症的预防与诊治

Prevention, Diagnosis and Treatment of Biliary Tract Complications after Liver Transplantation

目的探讨肝移植术后胆管并发症发生的原因,就其预防、诊断和治疗提出对策。方法复习近年来国内、外相关文献并进行综述。结果肝移植术后胆管并发症形成的原因相当复杂,预防的方法目前还没有统一的标准。治疗措施根据其形成的原因不同而有所差别。结论保存性损伤和缺血性损伤以及手术技术不佳和胆管的血液供应不良都是肝移植术后发生胆管并发症的重要原因。改进T管置管方法可显著降低与T管相关的胆管并发症的发生率。胆道充分冲洗,尽量减少对供者胆管血供的损害以及实现精细胆管黏膜无张力对端吻合是预防胆系并发症的关键。联合应用胆管造影技术和核磁共振胆胰管成像能了解胆树全貌,有助于胆管狭窄、胆泥淤积与胆瘘的诊断,及时采用放射介入技术处理胆管并发症可取得良好疗效。

Objective To investigate the causes of biliary tract complications after liver transplantation, and to put forward effective measures of prevention, diagnosis and treatment. Methods The literatures of recent years were reviewed and summarized. Results The causes of biliary tract complications after liver transplantation are very complex, and there are no standard preventive measures. Treatment differs according to causes. Conclusion One of the most important causes leading to biliary complications is preservative and ischemic injury. Poorly operative techniques and blood supply to biliary tract are also disastrous. Improving T tube placement can reduce the incidence of biliary complications related with T tube. To prevent biliary complications, it is crucial to completely wash the biliary tract, avoid damaging the blood supply to donor biliary tract and manage perfect biliary mucosa-to-mucosa anastomosis without tension. T tube cholangiography combined with noninvasive MRCP enables accurate depiction of the biliary tree and diagnosis of biliary complications. Doppler ultrosonography should be routinely applied postoperatively. Timely application of interventional radiological technique is a valuable nonoperative procedure for treatment of biliary complications. Meanwhile, biliary sludge or cholestasis and mixed infections of biliary tract should be handled actively and properly.