肝移植中胆总管重建的术式探讨

Two operation procedures for bile duct reconstruction of liver transplantation

目的 探讨不同的胆总管吻合术式对胆道并发症发生的影响。方法 利用猪的原位全肝移植模型 ,分别行胆总管侧侧 (n =6)和胆总管端端 (n =17)两种重建方式。比较分析它们在移植术后 7d内的肝功能改变及其死亡原因。结果 虽然两组术后的总胆红素值呈逐渐升高的趋势 ,但侧侧组的总胆红素值显示了有统计学意义的低值变化。反映肝细胞功能损害的血清谷草转氨酶和反映肝窦状内皮细胞损害的血清透明质酸在侧侧组中分别呈现了有统计学意义的低值。死亡时确认有黄疸肝侧侧组 1头 (17% ) ,端端组 5头 (2 9% )。结论 胆总管侧侧吻合术被认为是肝脏移植中有效的胆道重建术式。

Objective To study the relationship between operation procedure of bile duct reconstruction and postoperative complications. Methods In two groups of pig models of orthotopic liver transplantation, side-to-side bile duct anastomosis was applied in 6 cases, and, end-to-end in 17 cases. Hepatic function was followed seven days postoperatively and causes of death were analyzed. Results Although total bilirubin elevated gradually postoperatively in both groups, total bilirubin, AST and hyaluronic acid were significantly less high in side-to-side group ( P <0 05). On autopsy of death animals, one case of icterus liver was found in side-to-side group and five cases was found in end-to-end group. Conclusion Side-to-side bile duct anastomosis is an effective bile duct reconstruction in liver transplantation.