活体肝移植术后供体胆漏的诊治体会

Experience in diagnosis and treatment of donor bile leakage after living donor liver transplantation

目的总结活体肝移植术后供体胆漏的诊治经验。方法回顾性分析95例活体肝移植供体的临床资料,了解术后胆漏并发症发生情况,重点分析胆漏并发症供体的临床表现、处理方法及治疗效果。结果95例肝移植供体术后发生胆漏9例,胆漏的发生率为9%。9例胆漏供体的供肝部位均为左外叶,均为肝断面迟发型胆漏,临床表现无典型胆汁性腹膜炎表现,血清胆红素升高。给予经皮穿刺引流或保留引流管处理后均治愈,无二次手术及死亡病例。结论活体肝移植供体术后应注意监测供体肝功能及肝动脉血流动力学变化,对并发胆漏的供体予以积极治疗,预后良好。

Objective To summarize the experience in diagnosis and treatment of donor bile leakage after living donor liver transplantation. Methods Clinical data of 95 donors underwent living donor liver transplantation were retrospectively analyzed. Postoperative complications of bile leakage were observed,and clinical performance,treatment methods and therapeutic effects were analyzed. Results Bile leakage occurred in 9 donors of 95 donors with liver transplantation,and the incidence was 9%. The location of donor liver was left lateral lobe in 9 cases with bile leakage,all of which were delayed bile leakage of liver section. The clinical performance showed no typical bile peritonitis with increased serum bilirubin. All patients were cured after treatment of percutaneous puncture drainage or drainage tube retention,and there were no cases underwent second operation and death cases. Conclusions Changes in donor liver function and hepatic artery hemodynamics shall be monitored after living donor liver transplantation,and the donors with bile leakage shall be treated actively and will achieve favorable prognosis.