成人活体肝移植胆道并发症的防治  

Prevention and treatment of biliary tract complications following adult living donor liver transplantation

作　　者：夏天[1] 严律南[1] 李波[1] 曾勇[1] 文天夫[1] 赵继春[1] 王文涛[1] 杨家印[1] 徐明清[1] 马玉奎[1] 陈哲宇[1] 吴鸿[1] 

机构地区：[1]四川大学华西医院肝移植中心,成都610041

出　　处：《中华医学杂志》2008年第44期3138-3140,共3页National Medical Journal of China

摘　　要：目的探讨成人活体肝移植胆道并发症的防治策略。方法回顾性分析2002年1月至2007年8月间108例成人活体肝移植胆道并发症的发生与处理，其中102例为不含肝中静脉（MHV）右半肝移植，6例双供肝移植（双亲属左半肝1例，亲属右半肝加左半肝3例，亲属右半肝加尸体左半肝2例）。结果受体并发症共24例（22．2％），其中胆漏4例，肝断面胆漏1例，胆管吻合口狭窄3例；供体并发症共7例（6．3％），其中残留肝断面胆漏2例。胆道并发症者除1例死亡外，其余均经及时处置，恢复良好。结论改进术前、术中检查与评估方法，选择适当的胆道重建方式，结合显微手术技术精细操作，及时发现与处置，可明显地降低成人活体肝移植胆道并发症的发病率与病死率。Objective To investigate the prevention and treatment of biliary tract complications following adult-adult living donor liver transplantation （ A-A LDLT）. Methods One hundred and eight patients, aged 38 （18 -63 ）, underwent A-A LDLT, including transplantation of the right liver graft without middle hepatic vein （MHV） in 102 cases and dual graft transplantation in 6 cases （ of left lobe from relative in 1 case, of right lobe ＋ left lobe from relative in 3 cases, of fight lobe from relative ＋ cadaveric left lobe in 2 cases ）. Preoperative 3-dimensional computerized tomography （3D CT ） and intra-operative cholangiography were employed to reveal the state of the liver, caution was exercised to protect the peripheral vasculature of the right hepatic duct during resection. The bile duct was reconstructed by duct-to-duct （ D- D） biliary anastomosis or Roux-en-Y anastomosis of the hepatic duct and jejunum （H-J）. Results Twentyfour of the 108 patients （ 22. 2% ） suffered from complications, including bile leakage （ n = 4 ）, cutting surface bile leakage （n = 1 ）, and anastomotic biliary stricture （n =3）, etc. Seven donors （6. 3% ） suffered from complications too, including 2 cases of bile leakage from the remnant cut surface. All the biliary tract complications were properly managed with good outcomes, except for 1 case of recipient death. Conclusion Measures such as improvement of preand intra-surgical examinations and assessments, choice of appropriate approach of biliary tract reconstruction, employment of subtle operations of microscopic procedures, and timely detection and management of complications may reduce the incidence and mortality of biliary tract complications following A-A LDLT.

关 键 词：活体供者 肝移植 胆道并发症 预防综合 治疗 

分 类 号：R686[医药卫生—骨科学]