原位肝移植术后胆漏的诊断和治疗  

Diagnosis and treatment of bile leakage after orthotopic liver transplantation

作　　者：汪根树[1] 陈规划[1] 何晓顺[1] 朱晓峰[1] 陆敏强[1] 杨扬[1] 蔡常洁[1] 王国栋[1] 

机构地区：[1]中山大学第一附属医院器官移植中心

出　　处：《中华普通外科杂志》2004年第12期713-715,共3页Chinese Journal of General Surgery

基　　金：卫生部临床学科重点项目 (2 0 0 13 2 1) ;广东省科委攻关项目 (99B0 670 5G)

摘　　要：目的　探讨原位肝移植 (orthotopiclivertransplantation ,OLT)术后胆漏的诊断和治疗方法。方法　回顾性分析 12例患者OLT术后胆漏的诊断和治疗。 12例中男 9例 ,女 3例 ,平均年龄 (45±10 )岁。 3例行经典式OLT ,9例行背驮式OLT。胆管重建方式均为胆总管端端吻合术 ,其中 9例放置“T”形管引流。诊断主要依据临床表现及胆管造影。胆漏平均诊断时间为 (8± 6 )d。 7例经非手术治疗 ,包括保持腹腔引流通畅、重置引流管、鼻胆管引流、B型超声引导穿刺抽吸引流及抗炎治疗 ;5例经手术治疗 ,包括胆总管 空肠吻合术、“T”形管重置术或吻合口修补术。结果　 10例治愈 ,2例死于严重全身感染。结论　OLT术后胆漏的诊断主要依据临床表现及胆管造影。高龄患者或合并有胆道缺血者预后差。Objective To investigate diagnosis and treatment of bile leakage after orthotopic liver transplantation (OLT) Methods Twelve cases of bile leakage after OLT were analyzed retrospectively There were 9 males and 3 females The mean age was (45±10) yrs Three patients received classic OLT and 9 received piggy back OLT Bile ducts were reconstructed by end to end anastomosis of the common bile duct T tube drainage was used in 9 patients The diagnosis was established mainly by symptom, sign and cholangiography The mean diagnosis time was (8±6) d Seven patients received nonsurgical therapy including keeping patent peritoneal drainage, nasobiliary tube drainage, draining biloma percutaneously and use of antibiotics Five patients received reoperations including choledochojejunostomy, replacement of T tube and repairs of anastomosis Results Ten patients were cured and 2 died of severe systemic infection Conclusion The diagnosis of bile leakage after OLT depends mainly on clinical symptom, sign and cholangiography Elder patients and those with biliary ischemia often have a poor prognosis

关 键 词：术后胆漏 诊断和治疗 “T”形管 胆管造影 原位肝移植术 胆总管 引流 临床表现 穿刺抽吸 B型超声引导 

分 类 号：R657.3[医药卫生—外科学]