肝移植术后胆道并发症的早期发现与诊断

Early discovery and diagnosis for biliary complication after liver transplantation

目的探讨肝移植术后胆道并发症(biliary complication,BC)早期发现线索及诊断方法。方法分析BC的时间特点及临床表现,对BC患者与未发生BC患者的早期有关指标变化进行统计学分析。结果 181例肝移植中发生BC 26例(14.36%),其中22例(87.9%)BC发生于术后1年内。BC的临床表现多样,主要为胆道梗阻和感染症候群,其ALP、GGT增加幅度较TBIL、ALT更为明显,术后早期肝动脉阻力指数(HARI)出现偏高或偏低。结论临床表现、发生时间、肝功能中TBIL、ALT和ALP、GGT增幅分离现象以及术后早期HARI的异常有助于BC的早期发现和诊断。

Objective To explore the keys contributing to the early discovery of biliary complication（BC） and the ways of early diagnosis of BC in a large subjects undergoing liver transplantations（LT） retrospectively.Methods The clinical data of 181 patients receiving LT were collected completely.The time and the clinical manifestations of BC cases were analyzed.The early change of indexes of BC cases were evaluated by using statistic analysis.Results Twenty-six（14.36%） recipients developed BC,22 cases suffered from BC within 1 year.The clinical manifestations of BC were multiplicity,including the syndromes caused by obstruction and infection of bile ducts.Statistical analysis revealed that TBIL,ALT,ALP,GGT increased in different extent,the increase of ALP and GGT were more obvious.HARI associated with BC was on the high or low side of the average at early postoperative phase.Conclusion Clinical manifestation,time,separated amplitude of TBIL,ALT and ALP,GGT,abnormity of HARI at early postoperative phase are helpful to discover and di-agnose BC in time.