肝移植治疗复杂性胆道损伤

Liver transplantation in treatment of complicated biliary injury

目的探讨肝移植在胆道损伤修复失败病例中的应用价值。方法回顾分析2006年11月至2007年5月上海交通大学医学院附属瑞金医院收治的2例胆道损伤修复后失败而行肝移植治疗的病例资料。结果1例病人因腹腔镜胆囊切除造成胆道损伤(Stragsberg E4型)合并肝固有动脉损伤,经胆肠Reux-en-Y吻合修复失败后而行尸体肝移植;另1例病人是由于幼时外伤而造成胆道损伤(Stragsberg E2型),虽历经多次修复手术,但最终发展为继发性胆汁性肝硬化而行活体肝移植。经初步随访2例病人的肝移植效果满意。结论当胆道损伤合并严重血管损伤,或修复失败发展至继发性胆汁肝硬化时需要考虑行肝移植治疗。

Objective To investigate liver transplantation in treatment of failed cases after surgical interventions for bile duct injury. Methods From November 2006 to May 2007, two cases of failed cases after surgical interventions for bile duct injury were admitted into our hospital These clinical data were analyzed retrospectively. Results Bile duct injury （Strasberg E4） in one patient was caused by laparoscopic cholecystectomy concomitant with proper hepatic artery lesion, after the failure of previous Roux-en-Y hepaticojejunostomy, the patient received corpse liver transplantation. Bile duct injury （Strasberg E2） in another patient was caused by abdominal trauma in childhood, after several unsuccessful surgical interventions, the patient developed secondary biliary cirrhosis, and therefore, received living related liver transplantation. The outcome of both patients was satisfactory. Conclusion Liver transplantation should be considered when bile duct injury happens concomitant with severe vascular injury or secondary biliary cirrhosis occurs after failure of surgical intervention.