摘要
目的 探讨原位肝移植术后胆道并发症的诊治。方法 回顾性分析 4 0例原位肝移植的临床资料 ,总结术后胆道并发症的防治经验。结果 3例患者术后出现血胆红素和 /或转氨酶持续性升高 ,经T管胆道造影术及核磁共振胆胰管成像证实存在胆道狭窄 ,其中 2例为肝门部胆管与肝总管狭窄 ,1例为吻合口处胆管狭窄。经采用T管窦道球囊扩张术 ,3例的胆道狭窄得以改善 ,肝功能好转 ,其中 1例经 3次选择性球囊扩张 ,现健康存活已 2 1月余 ;其中合并胆漏的 1例 ,在B型超声波引导下穿刺置管负压引流后治愈 ;合并胆道胆泥淤积的 1例及合并多重胆道感染的 2例 ,均予以对症治疗。结论 手术技术不佳及胆管的血液供应不良是肝移植术后发生胆道并发症的重要因素 ;联合应用胆道造影术和核磁共振胆胰管成像能了解胆树全貌 ,有助于胆道狭窄、胆泥淤积与胆漏的诊断 ;
Objective To explore the diagnosis and appropriate management strategies of biliary complications after orthotopic liver transplantation.Methods The clinical data of 40 patients who underwent liver transplantation consecutively between January 1999 and December 2000 were analyzed retrospectively. Results Biliary continuity was routinely established by an end to end choledochocholedochostomy (C C) over a T tube, with only one exception by a Roux en Y choledochojejunostomy. Three cases deve loped biliary strictures accompanied with elevated bilirubin and(or) aminotransferase confirmed by T tube cholangiography and magnetic resonance cholangiopancreatography (MRCP) and subsequently treated by balloon catheter dilation successfully. Other complications included bile leak in one case,biliary sludge in one and biliary tract infections in 2. One patient suffered from acute rejection and 2 from chronic rejections proved pathologically by biopsy.Conclusion Strictures and bile leaks are the common complications posttransplantation. The fundamental rule is assurance and protection of blood supply of biliary tract. Early diagnosis is important and liver biopsy is necessary for detection of simultaneous rejections following liver transplantation. T tube cholangiography combined with noninvasive MRCP enables accurate depiction of the bile tree and detection of biliary complications. Doppler ultrosonography should be routinely applied posttransplantation. The timely interventional radiological technique is a valuable nonoperative procedure for treatment of biliary complications. Meanwhile, biliary sludge or cholestasis and mixed infections of biliary tract should be handled actively and properly.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2002年第3期154-156,共3页
Chinese Journal of Organ Transplantation
关键词
原位肝移植
胆道并发症
诊断
治疗
手术后并发症
Liver transplantation
Postoperative complications
Diagnosis
Therapeutics
