肝移植术后肝内外多发缺血型胆道病变的治疗分析  

Treatment and prognosis of multiple intra- and extrahepatic ischemic-type biliary lesions following liver transplantation

作　　者：易述红[1] 蔡常洁[1] 陆敏强[1] 杨扬[1] 王卫东[4] 郑丰平[2] 单鸿[3] 姜在波[3] 许赤[1] 李华[1] 易慧敏[1] 汪根树[1] 陈规划[1] 

机构地区：[1]中山大学器官移植研究所,中山大学附属第三医院肝脏移植中心,广州510630 [2]中山大学器官移植研究所,中山大学附属第三医院消化科,广州510630 [3]中山大学器官移植研究所,中山大学附属第三医院介入科,广州510630 [4]广东省人民医院肝胆外科

出　　处：《中华肝胆外科杂志》2008年第12期869-871,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家重点基础研究发展计划（973课题）项目基金（2003CD515507）;广州市科技局计划项目基金（200523一E0i01）

摘　　要：目的探讨原位肝移植术后肝内外多发缺血型胆道病变的治疗及预后。方法回顾性分析2003年12月至2006年5月收治的31例肝移植术后并发肝内外多发缺血型胆道病变病例的临床资料，总结此类病例的治疗选择策略及相应预后。结果31例病例中，男28例，女3例；年龄32～66岁，平均年龄（48．6＋9．6）岁。平均发生时间在肝移植（271．29±149．32）d，合并严重肝动脉狭窄8例，合并胆漏1例，采用介入治疗8例、介入治疗＋再移植术7例、再移植术5例。内科治疗8例，胆肠吻合术1例、2例病人放弃治疗。6例痊愈，均为再移植病人，好转7例，无效6例，死亡10例，死因为多器官功能衰竭（6例），胆道感染（3例），非胆道病变（1例）。总治愈率和死亡率分别为19．4％（6／31）和32．3％（10／31）。反复介入治疗后无论施行肝移植与否，均具有较高的死亡率（53．3％，8／15）。8例内科保守治疗病人有6例病情好转并相对稳定，1例胆肠吻合病人出现反复胆道感染。结论对肝移植术后肝内外多发缺血型胆道病变，介入方法的诊断价值高于治疗价值，合理的内科治疗有助于病情的稳定及推迟再移植的时间，而正确把握再移植的时机是治愈本病的关键。Objective To evaluate the treatment and prognosis oi multiple mtra-and extrahepat ic ischemictype biliary lesions （ITBLs） following liver transplantation. Method A retrospective analysis was made for 31 cases with ITBLs after liver transplantation from December 2004 to May 2006. Results Of the 31 cases with a mean age of（48.6＋9.6） years, 28 were male and 3 female. The mean interval from operation to diagnosis of ITBLs was （271.29 ± 149.32） d. Oonly 8 cases combined with severe hepatic artery stenosis and 1 case with bile leakage. The treatment options were divided in to five categories： （1） Interventional treatments （using ERC or PTC） in 8 cases. （2） Interventional measures were the first-line treatment and then retransplantation in 7 cases. （3） retransplantation without interventional measures in 5 cases. （4） conservative treatment in 8 cases. （5） hepaticjejunos tomy in 1 case. Six of the 31 cases were cured, the condition of 7 patients was improved, and 10 patients died. The mortality was 32. 3% （10/31）. Interventional measures were associated with high mortality （53.3%, 8/15）whether these cases received retrasnplantation or not. Six cases were im- proved when they only received conservative treatment and 1 suffering from refractory biliary inlet tions treated with hepaticojejunostomy. Conclusion Interventional treatment could not help to cure the cases with multiple intra-and extrahepatic ITBLs or improve their condition. Proper conservative treatment can effectively avoid or at least delays retransplantation. Timely re-transplantation is essential to cure this complication.

关 键 词：肝移植 手术后并发症 胆道 

分 类 号：R686[医药卫生—骨科学]