肝移植术变异胆管胆漏的预防与处理

Prophylaxis and treatment of bile leakage from anormous hepatic ducts after liver transplantation

目的探讨肝移植术中变异肝管胆漏的预防及治疗。方法回顾性分析我院3例肝移植术后发生变异肝管胆漏的诊断及预防、治疗方法。3例供肝切取均采用肝肾联合切取的方法，胆管重建方式为胆总管端端吻合。结果1例右后叶副肝管汇入胆囊管患者在胆管吻合后发现肝门处胆囊管残端胆汁漏出，立即拆除原胆管吻合口，成型后一期吻合，术后痊愈。1例Luschka胆管漏患者术后胆漏经过充分引流漏口自行闭合痊愈，但最后终因肝内外感染而于术后7个月再次肝移植。另一例右后叶副肝管汇入胆总管患者，术中遗漏断端导致术后胆漏。该患者因严重并发症行二次肝移植。结论了解肝内外胆管的解剖和常见变异形式，供肝修整时仔细辨认肝门组织，提高对存在副肝管及迷走胆管变异的警惕性，对预防肝移植术后胆管断端胆漏的发生非常重要。

Objective To investigate prophylaxisand treatment of bile leakage from hepatic duct anomalies after liver transplantation. Methods We retrospectively analyzed 3 patients with bile leakage from hepatic duct anomalies after liver transplantation in our institute. The graft procurements were combined liver-kidney harvesting. The reconstruction of the bile ducts was end-to-end anastomoses. Results In the first patient with a right accessory duct joining the cystic duct, leakage of bile came from the stump of the cystic duct after anastomosis of the bile ducts. The original anastomosis was taken down, and reanastomosis was performed after plasty of the bile ducts. The patient recovered uneventfully. In the second patient with a Luschka bile duct, the biliary fistula closed spontaneously after percutaneous drainage. However, re-transplantation was performed for severe infection 7 month after the primary transplantation. In the third patient with an accessory hepatic duct from the right posterior sector joining the common bile duct, the bile duct stump which we missed leaked bile. Re-transplantation was performed because of severe complications. Conclusion Understanding the anatomy of intra- and extra-hepatic bile ducts and their common anomalies identifying the structures in the porta hepatis during preparation of the liver grafts, and looking for possible accessory hepatic ducts and aberrant bile ducts are important steps to prevent bile leakage in liver transplantation.