成人肝移植术后胆道并发症的诊治分析

Diagnosis and treatment of biliary complications after adult liver transplantation

目的探讨原位肝移植术后胆道并发症的诊断及有效治疗方法。方法回顾分析2004年8月至2011年12月施行的253例次原位肝移植(其中2例次为二次肝移植)的临床资料,对35例次胆道并发症的诊断及治疗经验进行总结分析。结果 253例次原位肝移植,其中35例次发生胆道并发症,发生率为13.8%,其中胆道狭窄21例(60%),包括胆管吻合口狭窄13例(6例合并有胆道结石/胆泥),非吻合口胆管狭窄8例;胆漏12例(34.2%),其中4例合并有吻合口狭窄;胆道出血2例(5.7%)。35例次患者中行ERCP处理17例次(48.6%),治愈及好转26例次(74.3%),1例次行二次肝移植,死亡2例次。结论胆道并发症首先应考虑非手术治疗(包括ERCP),而非手术治疗效果不佳的患者,再次手术胆道探查是必要的治疗手段,对于严重胆道损伤导致移植物功能丢失,二次肝移植是唯一的选择。

Objective To study the methods of diagnosis and effective treatment of biliary complications after orthotopic liver transplantation.Methods The clinical data of 253 cases of orthotopic liver transplantation from August 2004 to December 2011 were retrospectively analyzed,then we analyzed on the diagnosis and treatment experience of 35 cases with biliary complications.Results Among 253 cases underwent orthotopic liver transplantation,35 cases developed biliary complications,the rate was 13.8%.There are 21 cases with biliary stricture（60%）,including biliary anastomotic stenosis in 13 patients（6 patients with biliary stones/biliary sludge）,non-anastomotic biliary stricture in eight cases.And there are 12 cases with bile leakage（34.2%）,including four cases with anastomotic stricture.Also there are 2 cases with biliary tract bleeding（5.7%）.Of 35 cases,17 cases（48.6%） were underwent ERCP treatment.After treatment,26 cases（74.3%） were cured or improved liver function,1 cases underwent re-transplantation and 2 cases died.Conclusions Most of the cases with biliary complications achieve a satisfactory effect after non-surgical treatment（including ERCP）.For patients with poor non-surgical treatment effect,bile duct reoperation is one of the effective mean,while re-transplantation is the only treatment for patients with graft failure.