肝移植术后早期肝动脉血供不良与胆道并发症  

Biliary complications following early hepatic arterial insufficiency in liver transplantation

作　　者：郑树森[1] 徐骁[1] 梁廷波[1] 陈海勇[1] 王伟林[1] 吴健[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华医学杂志》2005年第24期1665-1669,共5页National Medical Journal of China

基　　金：国家重点基础研究发展计划资助项目(2003CB515501);浙江省科技厅基金资助项目(2004C13043)

摘　　要：目的分析肝移植术后早期肝动脉血供不良(HAI)背景下胆道并发症(BC)的临床转归。方法自1999年2月至2004年2月,本单位共施行原位肝移植术240例。术中肝动脉和胆道重建均采用改良的显微外科吻合技术,术后动态监测肝动脉血流动力学及胆树完整性,回顾性研究肝移植术后早期HAI对胆道并发症发生与预后的影响。结果32例(13.3%)受体发生胆道并发症,其中11例(4.6%)病人移植后早期出现HAI(HAI组),21例(8.7%)移植后早期未出现HAI(nonHAI组)。HAI组包括3例肝动脉血栓形成(HAT)和8例肝动脉狭窄(HAS)。3例HAT病人均成功实施急诊取栓术,2例HAS病人接受短期抗凝药物治疗。HAI组术后出现7例胆道狭窄和4例胆漏,6例行内镜和/或放射介入治疗,4例行吻合口修补及胆道引流术,1例行药物治疗。8例病人死亡,3例治愈。HAI组病人术前血清总胆红素水平显著高于nonHAI组(373μmol/L±94μmol/Lvs111μmol/L±45μmol/L,P=0.008)。HAI组病人的1年和3年生存率分别为54.6%和16.4%,nonHAI组为66.3%与61.2%,两组差异有统计学意义(P=0.042)。结论肝移植术后早期出现HAI的胆道并发症病人预后不良;移植后早期应加强彩色多普勒超声动态监测,尽快恢复肝动脉正常血流;具有早期HAI背景者一旦发生胆道并发症,需及时施行介入治疗或中转手术并考虑再次肝移植的必要性。Objective To explore the clinical feature and treatment efficiency of patients with early hepatic arterial insufficiency (HAI) and biliary complications (BC) following liver transplantation (LT). Methods The clinical data of 240 patients receiving LT from February 1999 to February 2004 were analyzed retrospectively. End-to-end choledococholocostomy was applied to 236 patients as the major biliary reconstructive method. Hemodynamic monitoring of the hepatic artery was performed to discover HAT, including hepatic arterial thrombosis (HAT) or hepatic arterial stenosis (HAS) in the first 3 months after transplantation. Results In HAI Group, 7 cases of stricture of biliary tract and 4 cases of biliary leakage occurred; and 6 cases underwent endoscopic and/or intervention treatment, 4 cases underwent repair of anastomotic stoma and biliary drainage, 1 case underwent medication. Eight patients died and 3 were cured. A total of 32 patients (13.3%) developed biliary complications (BCs), Eleven of the 32 patients with BCs, biliary stricture in 8 cases and biliary leakage in 3 cases, had early HAI (HAI Group) with an incidence of 4.6% for BC with background of HAI (11/236). Another 21 patients with BCs (21/236, 8.7%) did not showed background of HAI (non-HAI Group). Preoperative serum total bilirubin levels were 373.3±93.9 μmol/L in HAI Group and 110.8±45.0 μmol/L in non-HAI Group (P=0.008). Three cases with HAT underwent emergency thrombectomy then the hepatic arterial flow turned to normal. Two cases with HAS received short-term anticoagulant therapy. Recipients with BC underwent radiological and/or endoscopic interventional treatment (n=6), surgical repair of leak site and biliary drainage (n=4), and ordinary medication (n=1). The 1 and 3-year survival rates of HAI Group were 54.6% and 16.4% respectively; both significantly lower than those of non-HAI Group (66.3% and 61.2%, both P=0.042). Conclusion The recipients with BC following early HAI are associated with poor outcome. The monitoring protocol of hepatic hemody

关 键 词：胆道并发症 肝动脉血供 术后早期 mol/L 2004年2月 动脉血流动力学 肝动脉血栓形成 原位肝移植术 放射介入治疗 超声动态监测 HAI 药物治疗 1999年 回顾性研究 肝动脉狭窄 胆道引流术 胆红素水平 3年生存率 彩色多普勒 

分 类 号：R657.3[医药卫生—外科学] R779.64[医药卫生—临床医学]