You Position: Home > Paper
Biliary reconstruction and treatment of biliary complications in orthotopic liver transplantation
( views:271, downloads:16 )
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF ORGAN TRANSPLANTATION
- Issue:
- 8
- DOI:
- 10.3760/cma.j.issn.0254-1785.2005.08.003
- Key Word:
- 肝移植;胆管;手术后并发症
Abstract： 目的探讨同种原位肝移植(OLT)的胆管重建方式及其术后并发症的防治.方法回顾性分析1999年2月至2003年1月间103例终末期肝病患者施行OLT胆管重建及术后并发症的防治情况.103例患者中,75例采用经典式原位肝移植伴体外静脉转流、17例采用经典式原位肝移植不伴转流、11例采用背驮式原位肝移植.胆道重建过程中有94例行胆管端端吻合,9例行胆肠吻合.胆管端端吻合的患者中,62例带T管引流,32例不带T管,但11例经受者胆囊管置入小橡胶管引流.术后胆管并发症的诊断主要依据临床表现、B型超声波、磁共振胰胆管成像或逆行胰胆管造影检查.所有患者均随访1年以上.结果103例OLT患者术后胆管并发症发生率为7.8%(8/103).62例带T管引流的患者中,6例(9.6%)发生胆管并发症,其中4例术后发生胆漏,2例拔除T管后发生局限性腹膜炎;32例不带T管引流的患者中,1例(3.1%)发生胆管狭窄.9例胆肠吻合中,1例(11.1%)术后发生胆漏.7例胆漏患者,2例经再次手术引流,其余继续保持引流胆漏自愈.不带T管引流的患者中的胆管狭窄为吻合口狭窄,经内镜取出异物、球囊扩张与安放内支架后治愈.1例患者因胆漏导致肝动脉吻合口假性动脉瘤及腹腔大出血,经介入法明确诊断并行栓塞治疗后治愈.患者中无胆管并发症而引起的死亡.结论胆管吻合口的胆漏与狭窄是OLT术后最常见的胆管并发症.良好的胆管血供与胆管吻合技术是防止胆管并发症发生的关键.及时的内镜检查与放射学技术是诊断和治疗胆管并发症的有效手段.
- [1]赵纪春,卢实春,严律南,等.原位肝移植肝动脉重建及其并发症防治[J].2004,(3).
- [2]Lake JR,Roberts JP,Randall HB,etc.The use of the T tube after orthotopic liver transplantation.[J].1996,61(2).
- [3]J M, Northover,J, Terblanche.A new look at the arterial supply of the bile duct in man and its surgical implications.[J].1979,66(6).
- [4]K, Rolles,K, Dawson,R, Novell,etc.Biliary anastomosis after liver transplantation does not benefit from T tube splintage.[J].1994,57.
- [5]F, Greif,O L, Bronsther,D H, Van Thiel,etc.The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation.[J].1994,219.
- [6]Punch JD,Sawyer RG.Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting.[J].1998,66(9).
- [7]Kramer DJ,Mazariegos GV,Molmenti EP.Early complications after orthotopic liver transplantation.[J].1999,79(1).
- [8]T E, Starzl,C W, Putnam,J F, Hansbrough,etc.Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair.[J].1977,81.
- [9]L S, Leonardi,I F S F, Boin,F C, Neto,etc.Biliary reconstructions in 150 orthotopic liver transplantations: an experience with three techniques.[J].2002,34(4).