应用显微外科技术进行活体肝移植的胆道重建  

Introduction of microvascular surgery to biliary reconstruction in living donor liver transplantation

作　　者：严律南[1] 李波[1] 曾勇[1] 文天夫[1] 赵纪春[1] 王文涛[1] 杨家印[1] 徐明清[1] 马玉奎[1] 陈哲宇[1] 刘江文[1] 吴宏[1] 

机构地区：[1]四川大学华西医院普外科,肝移植中心,成都610041

出　　处：《中华医学杂志》2006年第22期1549-1552,共4页National Medical Journal of China

摘　　要：目的探讨采用显微外科技术行胆道重建以降低活体肝移植(LDLT)术后胆道并发症发病率的可行性。方法对我院自2001年1月—2005年12月施行的32例LDLT患者(8例儿童,24例成人)进行分析,32个供肝移植物(其中右半肝24个,左半肝6个,左外叶2个)断面共有43个肝管开口,因此,共行43个肝管开口的胆道重建,胆道重建采用了显微外科技术,其中胆管对端吻合21个吻合口及22个肝管空肠吻合中的13个吻合口采用了手术放大镜下吻合,另外9个肝管空肠吻合口采用了手术显微镜下吻合。结果术后2例受体发生了胆道并发症,1例系在手术放大镜下行肝管空肠吻合,术后第3天出现吻合口漏,行再次开腹引流后痊愈,另1例于术后3个月发生轻度胆管对端吻合口狭窄,经保守治疗痊愈。结论在活体肝移植中采用显微外科技术行胆道重建,特别是对非常细的肝管(直径≤2mm)行肝管空肠吻合时采用手术显微镜下吻合,有助于降低LDLT术后胆道并发症的发病率。Objective To explore the feasibility of introduction of microvascular surgery into biliary reconstruction in living donor liver transplantation （LDLT） so as to reduce the incidence of postoperative biliary complications. Methods The experience in the microvascular surgery performed on 32 patients undergoing LDLT, 8 children and 24 adults, including duct-to-duct anstomosis in 21 case, hepatojejunostomy under surgical loupe in 13 cases, and hepato-jejunostomy under operative microscopy in 9 cases, totally 43 cases of biliary reconstruction manipulations. Results Post-operative biliary complications occurred in 2 patients. One male patient who underwent hepato-jejunostomy under surgical loupe suffered from leakage from a bilioenteric anastomotic stoma 3 days after operation and laparotomy was performed to repair the leakage and carry out drainage. Mild stricture of the anstomotic stoma occurred in the other patient 3 months after operation and conservative treatment was given. Both patients recovered. Conclusion Introduction of microvascular surgery to biliary reconstruction in LDLT, especially the use of operative microscopy for hepato-jejunostomy on very small hepatic ducts, ≤2 mm in diameter, achieves good results, with significant reduction of post-operative complications.

关 键 词：肝移植 活体供者 显微外科技术 胆道并发症 胆道重建 

分 类 号：R657.3[医药卫生—外科学]