胆管周围血管丛损伤与肝移植术后胆道并发症

Peribiliary vascular plexus damage and biliary complications after liver transplantation

背景:随着肝移植术后单纯胆管吻合所导致的胆道并发症明显下降,目前需要重视的是各种因素引起的胆管动脉血供受损所产生的缺血性胆管损害。目的:总结了胆道的解剖结构与胆管周围血管丛生理形态、肝移植对胆管周围血管丛的损伤及其导致胆道并发症的机制、以及如何预防胆管周围血管丛损伤。方法:应用计算机检索PubMed和CNKI数据库、万方、维普数据库中2010-12以前与肝移植和胆管周围血管丛相关内容的文章,在标题和摘要中以"肝移植,胆管周围血管丛,胆道并发症,胆管微循环,缺血再灌注损伤"或"liver transplantation,peribiliary vascular plexus,biliary complications,microcirculation of bile duct,ischemia-reperfusion injury"为检索词进行检索。初检得到228篇文献,根据纳入标准选择23篇文章进行综述。结果与结论:胆管的血供主要是由肝动脉通过胆管周围血管丛提供的,肝动脉的大部分终末分支形成胆管周围血管丛,承担胆管的血供和营养。在肝移植过程中胆管树潜在性遭受很多因素的损害,而大多数因素均是直接或间接地作用于胆管周围血管丛进而导致移植术后胆道并发症的发生。

BACKGROUND： With an obvious decrease in biliary complications caused by pure bile duct anastomosis after liver transplantation, ischemic biliary damage caused by damage to arterial blood supply due to various factors should be paid more attention. OBJECTIVE： To summarize the anatomical structure of bile duct, physiological morphology of peribiliary vascular plexus, mechanisms underlying the damage to peribilary vascular plexus caused by liver transplantation and resultant biliary complications and how to prevent the damage to peribiliary vascular plexus. METHODS： A computer-based online search of PubMed, CNKI, VIP and Wanfang databases was performed for relative articles about liver transplantation and peribiliary vascular plexus published before December 2010, with key words of ＂liver transplantation, peribiliary vascular plexus, biliary complications, microcirculation of bile duct, ischemia-reperfusion injury＂ in English and in Chinese by screening titles and abstracts. The contents of the article associated with liver transplantation and peribiliary vascular plexus were selected, and those published recently or in authoritative journals were preferred in the same field. RESULTS AND CONCLUSION： Totally 228 articles were obtained in initial retrieval, 23 articles of them were chosen to summarize based on inclusion criteria. The peribiliary vascular plexus was primarily composed of hepatic artery terminal branches, which provide bile duct blood supply and nutrition. The biliary tree was damaged by various factors in liver transplantation, and most factors directly or indirectly act on the peribiliary vascular plexus, leading to biliary complications.