摘要
目的探讨同种异体原位肝移植术后胆道并发症病因及处理。方法对北京地坛医院2004～2009年收治的74例同种异体原位肝移植术后胆道并发症患者的临床资料进行回顾性分析,总结肝移植术后胆道并发症的主要表现形式和致病高危因素,并对不同治疗方法的介入时机和治疗效果进行比较分析。结果胆瘘、胆泥形成、胆道吻合口狭窄、非吻合口胆道狭窄和胆管铸型综合征是本组患者肝移植术后胆道并发症的主要表现形式。供肝灌注保存、供肝胆道修整、移植术中血管与胆道吻合技术及术后处理经验不足是造成胆瘘与胆道吻合口狭窄发生的主要因素。供肝热缺血时间延长是诱发胆泥形成与胆道非吻合口狭窄的主要因素(P<0.01)。T管胆道外引流及胆肠吻合术患者较单纯胆道对端吻合患者术后早期胆道非吻合口狭窄发病显著增加(P<0.01)。腹主动脉采用UW液灌注病例术后胆泥形成、胆道非吻合口狭窄和胆管铸型综合征发病均显著高于非UW液灌注病例(P<0.05)。内镜及介入治疗胆瘘、胆泥形成、胆道吻合口狭窄等肝移植术后胆道并发症,疗效满意,但对于非吻合口胆道狭窄,尤其是胆管铸型综合征的治疗,疗效有限。对于内镜及介入治疗无效者需再次肝移植。结论肝移植术后胆道并发症与手术技巧、缺血再灌注损伤、胆道吻合方式、供肝灌注方式等因素有关。内镜和介入治疗对多数胆道并发症治疗有效。应重视胆道缺血性狭窄和胆管铸型综合征的预防,以降低其发病率。
Objective To investigate the pathogenesis of biliary tract complication following orthotopic liver transplantation （ OLT） and explore the methods of countermeasures. Methods Clinical data of 74 cases of biliary tract complication following OLT at our institute from 2004 to 2009 were retrospectively analysed. The patterns and high risk factors of biliary tract complication following OLT were summarized. Furthermore the interventing time and efficacy of any treatment for biliary tract complication following OLT were carefully analyzed. Results Bile leakage,biliary sludge,biliary duct stoma stricture,biliary ischemia stricture and biliary cast syndrome were predominant patterns of biliary tract complication following OLT. The inexperience in organ procurement,organ preservation,operating technique and post-operating treating was major factors for bile leakage and biliary duct stoma stricture. The prolong of warm ischemia time was the major factor for biliary sludge and biliary ischemia stricture （ P 〈0. 01） . At the same time the T-tube and cholangiojejunostomy could induce high morbility of biliary ischemia stricture（ P 〈0. 01） . The organs to be perfused with UW through abdominal aorta had higher morbilities in biliary sludge,biliary ischemia stricture and biliary cast syndrome than those no use with UW（ P 〈0. 05） . Endoscopic and radiative interventionswere effective methods for bile leakage,biliary sludge and biliary duct stoma stricture but unsatisfactory for treating biliary ischemia stricture and biliary cast syndrome. Retransplantation was a salvage method for invalid cases. Conclusions The biliary tract complication following OLT was directly associated with operation technique, ischemical reperfusion injury, the pattern of biliary duct anastomosis, organ procurement and so on. It was very important to think highly of preventing biliary ischemia stricture and biliary cast syndrome in order to cut down the morbilitis for those severe biliary tract complication following OLT.
出处
《中华临床医师杂志（电子版）》
CAS
2010年第11期27-31,共5页
Chinese Journal of Clinicians(Electronic Edition)
基金
首都特色临床医学应用发展项目(Z0005190043111)
关键词
肝移植
移植
同种
手术后并发症
胆道疾病
Liver transplantation
Transplantation,homologous
Postoperatiue complications
Biliary tract diseases
