胆道成形技术在肝移植胆道重建中的临床应用

Clinical application of biliary plasty during biliary reconstruction in liver transplantation

目的总结胆道成形技术在成人肝移植术中的技术操作,探讨其在肝移植胆道重建中的应用效果。方法回顾分析2017年1月至2018年12月在首都医科大学附属北京朝阳医院行肝移植手术并采用胆道成形技术进行胆道重建的36例受者资料。肝移植术中供肝或受者胆道断端直径小于4 mm或者两者直径差距较大的,行供肝或受者胆道成形后,再行胆道端端吻合。观察胆道吻合口愈合及胆道相关并发症发生情况。结果36例受者应用胆道成形技术,其中11例行供肝胆囊管-胆总管成形,14例行供肝胆囊颈部-胆总管成形,4例行供肝胆囊颈部-胆囊管-胆总管成形,4例行受者胆囊管-肝总管成形,3例同时行供肝胆囊颈部-胆总管成形和受者胆囊管-肝总管成形。术后随访20.8(10~34个月),1例受者围手术期出现胆漏,经手术治疗后痊愈。1例受者于术后6个月复查胆道吻合口狭窄,但总胆红素仍在正常范围内,行内镜下胆道支架植入后痊愈。结论对于供肝或受者胆道断端直径较细,或两者直径不匹配的情况,采用胆道成形技术重建胆道是安全可行的。

Objective To summarize biliary plasty in adult orthotopic liver transplantation and discuss its application for biliary reconstruction in liver transplantation.Methods From January 2017 to December 2018,retrospective analysis was conducted for clinical data of recipients undergoing liver transplantation and bile duct reconstruction by biliary plasty.If end diameter of biliary tract of donor/recipient was less than 4 mm or a large discrepancy of bile duct size existed between donor and recipient,donor or recipient biliary tract should be shaped before end-to-end biliary anastomosis.Follow-ups were conducted for healing of biliary anastomosis and biliary complications.Results Shaping of cystic duct or neck of gallbladder and common bile duct were performed in 36 recipients of orthotopic liver transplantation.The specific procedures included shaping of cystic duct and common bile duct for donor(11 cases),shaping of neck of gallbladder and common bile duct for donor(14 cases),cystic duct,common bile duct and neck of gallbladder for donor(4 cases),shaping of cystic duct and common hepatic duct for recipient(4 cases)and both shaping of neck of gallbladder and common bile duct for donor and shaping of cystic duct and common hepatic duct for recipient.One case of bile leakage during perioperative period was cured operatively.The median follow-up period was 20.8(10~34)months.One case had biliary anastomotic stricture formation at 6 months post-operation.However,total bilirubin stayed within a normal range.They were cured endoscopically.Conclusions It is both safe and feasible to reconstruct biliary tract for shaping of cystic duct or gallbladder ampulla and common bile duct for patients with a small diameter of donor/recipient or there is a wide discrepancy of bile duct size between donor and recipient in orthotopic liver transplantation.