原位肝移植术后胆道并发症的预防与处理

Prophylaxis and management of biliary tract complications after orthotopic liver transplantation

目的 探讨原位肝移植术后胆道并发症的发生原因及防治措施。方法 回顾性研究 110例原位肝移植的临床资料。结果 110例病人术后共发生胆道并发症 15例 (13 6 % )。其中单纯胆瘘 5例 ,迟发性弥漫性肝内胆管损伤 3例 ,拔除T管后胆瘘 2例 ,胆管空肠吻合口狭窄、肝内胆管结石、胆道狭窄合并胆泥形成、胆瘘后继发胆道狭窄、胆道狭窄合并肝内胆汁瘤形成各 1例。除 3例弥漫性肝内胆管损伤外 ,12例中 2例死于严重胆道感染 ,其余 10例经治疗痊愈。结论 原位肝移植术后胆道并发症病因复杂 ,治疗相对困难 ,因此首先应该注重预防 ,其次尽量做到早期诊断 ,针对不同的情况采取相应的治疗措施 ;

Objective To discuss the cause and management of biliary tract complications after orthotopic liver transplantation.Methods Clinical data of 110 patients who underwent orthotopic liver transplantation between May,2000 and Febrary,2003 were studied retrospectively.Results Among the 110 patients,15 (13 6%)patients developed postoperative bililary tract complications.Among them 5 patients had biliary fistula,3 patients had late diffuse injury of intrahepatic biliary tract,2 biliary leakage during T tube removal,1 stenosis of biliary jejunum anostomosis,1 calculus of intrahepatic biliary,1 biliary stricture combined with cholelith,1 stricture of biliary tract after biliary fistula and 1 biliary stricture with intrahepatic biloma.Except the 3 cases who had late diffuse injury of intrahepatic biliary tract,10 cases of the 12 patients survived and other 2 died of severe biliary infection.Conclusion Biliary complications are important factors determining postoperative survival.Their causes are complicated and results are severe.The management are difficult.So above all prophylaxis is the most important.Furthermore,early diagnosis should be made and pertinent management should be taken according to different types of complications.Assistant interventional therapy,such as ERCP and PTC,should be valued in order to improve the long term survival rate.