摘要
目的探讨原位肝移植术后胆道并发症的有效治疗方法。方法回顾分析2004年4月至2009年12月施行的382例次原位肝移植(其中10例次为二次肝移植)的临床资料,对40例次胆道并发症的治疗经验进行总结分析。结果 382例次原位肝移植中恶性肿瘤占150例次,良性肝病232例次,其中40例次发生胆道并发症,发生率为10.5%,分别为缺血性胆道损伤25例次(轻度5例次,中、重度20例次)、吻合口狭窄8例次、胆漏4例次、返流性胆道炎2例次、Odd is括约肌失弛缓1例次。40例次患者中行胆道手术探查处理25例次(63%),治愈及好转28例次,10例次需行二次肝移植(其中3例次死亡),共死亡5例次(13%)。结论部分轻度胆道并发症可经非手术治疗取得满意疗效,而中、重度病例及非手术治疗效果不佳的患者,再次手术胆道探查是较为确实可靠的治疗手段,对于部分严重缺血性胆道损伤导致移植物失功的病例,二次肝移植是唯一的选择。
Objective To study the effective treatment of biliary complications after orthotopic liver transplantation. Methods Clinical data of 382 patients who underwent orthotopic liver transplantation consecutively between April 2004 and December 2009 were retrospectively reviewed to study the morbility, causes and treatment of biliary complications. Results Among 382 cases undergoing orthotopic liver transplantation, 150 cases suffered from liver malignant tumors and another 232 cases suffered from benign liver diseases. Forty cases developed biliary complications including 4 cases with bile leakage, 8 cases with anastomotic strictures, 2 cases with reflux cholangitis, 1 cases with dysfunction of Oddi＇ s sphincter and 25 cases with ischemic injury of biliary tract. Of 40 cases, 25 cases underwent the exploration of biliary duet. After treatment, 28 eases were cured or improved liver function, 10 eases underwent re-transplantation and 5 eases died （13%）. Conclusions Non-operative treatment is effective for minor complications. The exploration of biliary duet is an effective measure to treat moderate-severe complications while re-transplantation is the only treatment for patients with graft failure.
出处
《器官移植》
CAS
2010年第3期166-169,共4页
Organ Transplantation
基金
国家自然科学基金项目(30671977)
首都医学发展基金项目(2005-2034)
关键词
肝移植
胆道并发症
缺血性胆道损伤
术后并发症
T管引流
Liver transplantation
Biliary complication
Ischemic biliary duct injury
Postoperativecomplication
T-tube drainage
