原位肝移植术后胆漏原因分析及预防措施探讨

Etiology and prophylaxes of bile leakage after orthotopic liver transplantation

目的 探讨原位肝移植术后胆漏原因及其预防措施。资料和方法 回顾分析 12例原位肝移植术后胆漏病例。其中男性 9例 ,平均年龄 (4 5± 9 5 )岁。 3例行“经典式原位肝移植术” ,9例行“背驮式原位肝移植术”。胆管重建方式均为胆总管端端吻合术 ,其中 9例放置“T”管引流。胆漏发现时间平均 (8± 6 5 )d。 7例经保守治疗 ,5例经手术治疗。结果 12例胆漏 ,10例治愈 ,2例并发感染死亡。结论 原位肝移植术后胆漏的发生与胆管吻合技术、供肝修剪技术、供肝缺血时间及术中、术后处理不当等因素有关。临床上 。

Objective To investigate the etiology and prophylaxes of bile leakage after orthotopic liver transplantation (OLT). Methods The clinical data of 12 patients with bile leakage after OLT (9 males and 3 females, mean age=45 ±9.5 yr) were retrospectively analyzed. The bile duct was reconstructed by end-to-end anastomosis of the common bile duct. The T tube was used in only 9 cases and the mean time for diagnosis of the bile leakage was 8±6.5 days. Of the 12 patients, 7 were conservatively and 5 surgically treated. Results Ten patients were cured and 2 died of severe complicated infections. Conclusions Poor techniques for anastomosis and repair of the graft, long ischemic time of the graft, improper treatment during and after operation and other factors may contribute to the bile leakage after OLT. Strong prophylactic measures should be taken to fight against those contributors to reduce the occurring rate of bile leakage after OLT.