肝移植术后胆道并发症的处理措施

Management of biliary tract complications after liver transplantation

目的:探讨肝移植术后胆道并发症的处理措施。方法:总结2005年3月～2007年11月在肝脏移植中心行肝移植手术的125例患者的临床资料,分析肝移植术后胆道并发症的治疗措施及效果。结果:125例肝移植患者中共有22例受体发生了胆道并发症,发生率为17.6%(22/125)。其中,4例为胆漏,13例为胆道狭窄,1例为胆管炎,2例为胆道吻合口狭窄合并胆漏,1例为胆漏合并胆道铸型,另外1例为吻合口胆漏合并肝内胆道狭窄及胆道铸型。4例胆漏均获得治愈。7例单纯吻合口狭窄患者中5例最初行内镜治疗,4例治愈;而有肝内胆管狭窄的6例胆道狭窄患者,均行内镜介入治疗,仅1例有效。13例胆道狭窄患者中,7例单纯吻合口狭窄的患者均治愈,患者存活,而有肝内胆道狭窄的6例患者,有5例死亡,经统计分析差异有统计学意义(P=0.005)。结论:单纯胆漏或单纯吻合口狭窄大多可以通过非手术方法治愈,而肝内胆管狭窄保守及内镜介入治疗效果较差,常常需要手术重建胆道或再次移植。

Objective： To evaluate the management of biliary tract complications after liver transplantation. Methods：All patient data were collected retrospectively onto a database at the liver transplantation center of the first affiliated hospital of Nanjing medical university with review of hospital records. Results： 22 biliary complications occurred in 125 grafts （17.6%）, including four biliary leaks, 13 biliary strictures, a eholangitis, two biliary leaks with strictures, a biliary leak with cast, a biliary leak with stricture and cast. All of four biliary leaks were cured. Four of five simple anastomotie strictures were resolved by endoscopic therapy, but only one of six patients with intrahepatic strictures was resolved by endoscopic therapy. Among the 13 patients with simple biliary strictures, all of seven patients with simple anastomic strictures were cured, while five of six patients with intrahepatie strictures died （83.3%） （P= 0.005）.Conclusion： Most of simple biliary leaks or simple anastomotic strictures can be resolved by non-operative management. However endoscopic or radiologieal management was ineffective in the management of intrahepatic strictures, which were best treated by surgical intervention reconstructing biliary tract or retransplantation.