肝脏移植术后胆道并发症的防治.doc

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1、肝脏移植术后胆道并发症的防治作者：史宪杰周宁新纪文斌陈永亮段伟东杨滔董家鸿黄志强　【摘要】目的探讨原位肝移植术后胆道并发症的防治方法。方法回顾性分析我院2002年6月至2006年9月完成的160例肝移植资料，其中行胆管空肠RouxenY吻合术10例、胆管胆管端端吻合术150例。术后超声、CT、MRI、胆道造影和血清学检查了解移植肝形态、血流动力学及肝功能。98例随访2～48个月。结果发生胆道并发症24例(18%)，其中因肝动脉狭窄或栓塞引起的胆漏、胆道狭窄和肝内局限性坏死7例(5例经溶栓及

2、内支架介入治疗后恢复、2例因肝功能衰竭并感染死亡)；胆道狭窄8例(6例经再次手术和ERCP及PTCD胆道内、外支撑等介入治疗恢复、2例胆管消融并发胆管炎死亡)；胆漏7例(6例经再次手术或超声引导下穿刺置管引流治愈、1例保守治愈)；胆道铸型2例(均经再次手术治愈)。结论供肝的质量和完整的动脉采集及胆道黏膜的保护，精细的动脉和胆管吻合是预防肝移植术后胆道并发症的关键。肝动脉溶栓、ERCP及PTCD胆道内支撑等是治疗胆道并发症的有效手段。【关键词】肝脏移植；胆道并发症【Abstract】Objectiv

3、eToinvestigatethepreventionandmanagementmethodsofbiliarycomplicationsafterorthotopiclivertransplantation(OLT).MethodsAretrospectiveanalysiswasdoneon160patientstreatedwithOLTfromJune2002toSeptember2006inourdepartment.Biliaryreconstructionwasperformedby

4、Rouxenycholedochojejunostomyin10patientsandendtoendanastomosisofbileductin150.Dopplerultrasonography,CT,MRI,cholangiographyandserologicexaminationwereperformedtounderstandmorphous,hemodynamicsandfunctionofthetransplantedliverafteroperation.Allpati

5、entswerefollowedupfor248months.ResultsBiliarycomplicationsoccurredin24patients(18%)including7withbiliaryfistula,biliarystrictureandhepaticlocalnecrosisduetothehepaticarterystrictureorthrombosis,ofwhom5recoveredafterthrombolysisandendoprosthesissuchas

6、hepaticarteryantithrombosisorplacementofintravascularstentbut2diedofhepaticfailurecomplicatedbyinfection.Biliarystrictureoccurredin8patients,ofwhom6recoveredafterreoperationandinterventionaltherapywithERCPandPTCDbut2diedofcomplicatedcholangitis.Bili

7、aryfistulaoccurredin7patients,ofwhom6werecuredbyreoperationandbiliarydrainageviaBmodeultrasonographyand1recoveredwithconservativetherapy.Intrabiliarymoldingsoccurredin2patientswhowerecuredbyreoperation.ConclusionsThedonor′squality,intactartery,protec

8、tionofbiliarymucosaandfineanastomoseofarteryandbile5ductarekeytopreventingbiliarycomplicationsfollowingOLT.Interventiontechniquessuchashepaticarteryantithrombosis,ERCPandPTCDareeffectivefortreatingbiliarycomplications.【Keywords】Livertransplan