肝移植术后胆道并发症的防治体会

Understanding of the Prevention and Treatment of Biliary Complications after Orthotopic Liver Transplantation

目的：报告本院１９９６年１２月～２００２年１月施行的１７例肝移植术后胆道并发症的诊治体会，探讨其发生的主要原因及防治方法。方法：终末期肝病合并症肝功能衰竭（部分合并肾功能衰竭）１７例。男∶女，８∶９；年龄３２～６５岁；原发病：原发性胆汁性肝硬化６例，肝炎后肝硬化４例，酒精性肝硬化一例，Ｗｉｌｓｏｎ＇ｓ病２例，多囊肝合并多囊肾２例，原发性肝癌一例，遗传性毛细血管增生症一例；肝功能状态：均为Ｃｈｉｌｄ Ｃ。结果：１７例病人中１４例获得长期存活，生活质量良好，３例术后短期生存。２例术后发生胆道梗阻并发症，均经再次手术治愈。结论：肝移植术后胆道并发症的诊断主要依靠Ｂ超、胆道造影等影像学方法。针对病因，确保胆道系统的血供，是预防肝移植术后胆道并发症的主要手段。在治疗上应视具体情况，争取切除梗阻部位、重建胆流通道。

Objective:To review the experience in biliary complications after liver transplantation, and to discuss the major causes and methods of their prevention and treatment. Methods:Five patients were diagnosed respectively hereditary capillary hyperplasia, alcoholic cirrhosis, primary biliary cirrhosis(2 casses) polycystic liver and kidney. Four received piggyback transplantation, one case received associated hepato-renal transplantation. Results:Cases 1 and 2 surffered from post-operative biliary obstruction, both of them were surgically cured with reversion of choledochocholedochostomy to choledochojejunostomy. Three patients acquired long-term survival with quite good health, and other two died 10 days and 30 days respectively after the operation.Conclusions:Ultrasonography and radiological examinations are the major methods for diagnosing post-operative biliary complications. To as prevention, the blood supply of the biliary duct must be respected. The major objectives of the surgical treatment for biliary complications are: resect the ischemic segment and re-establish the patency of bile flow.