原位肝移植中下腔静脉逆灌注法对胆道并发症的影响

Influence of retrograde reperfusion via vena cana on biliary complications after orthotopic liver transplantation

目的探讨原位肝移植中下腔静脉逆灌注法对肝移植术后胆道并发症的影响。方法对我院1999年10月至2007年10月间肝移植生存1年以上的86例病例进行回顾性分析。其中经典原位肝Σ植组36例、下腔静脉逆灌注原位肝移植组50例,观察各组胆道并发症的发生情况,分别对两组早期及晚期胆道并发症发生率进行统计分析。结果所有患者随访时间1个月～8年,总共有12例发生胆道并发症,发生率为13.95%。①原位肝移植组36例,5例发生胆道并发症,发生率为13.89%。其中2例为早期并发症;另3例为晚期并发症,5例患者经保守治疗后有好转。②下腔静脉逆灌注法原位肝移植组50例,7例发生胆道并发症,发生率为14%。其中3例为早期并发症,1例死于合并腹腔感染,2例经保守治疗后好转。另4例为晚期并发症,经保守治疗后好转。分别对两组早期及晚期胆道并发症发生率进行统计分析,无显著差异。结论下腔静脉逆灌注法并没有增加肝移植术后胆道并发症发生率。

Objective To prospectively compare the effects of retrograde reperfusion via vena cana on biliary complications after orthotopic liver transplantation （OIT）. Methods 86 eases of transplantation patients who survived more than one year were analyzed retrospectively from October 1999 to October 2007,orthotopic liver transplantation in 36 eases,retrograde reperfusion via caval veins in 50 cases. Biliary complications were ob- served in the situation. Results All patients were followed up for one month to eight years, 12 out of 86 cases （13.95%） developed biliary complications. 5 of 36 （14.29%） eases with orthotopie liver transplantation developed bilairy tract complications, two cases developped early biliary complications.another three cases developed ad- vanced biliary complications,they were cured. 7 of 50 （14%） cases with retrograde reperfusion via vena cana de- velopped bilairy tract complication. Three cases developed early biliary complications,1 cases died of abdominal cavity infection, another two cases were cured. Another 4 cases developed advanced biliary complications,they were cured. The study showed not difference in early biliary complications and advanced biliary complications between the two groups. Conclusion Retrograde reperfusion via vena cana does not increased the incidence of bile duct complications after liver transplantation.