原位肝脏移植后胆道狭窄的病因分析与处理  

Causes and treatment of biliary stricture following orthotopic liver transplantation

作　　者：李来邦[1] 李立[2] 冉江华[2] 李晓延[2] 曹海鹰[2] 张升宁[2] 赵永恒[2] 李铸[2] 刘静[2] 

机构地区：[1]昆明医学院附属昆明市第一人民医院,云南省昆明市650011 [2]昆明医学院附属昆明市第一人民医院肝胆胰一科及云南省器官移植研究所肝移植研究中心,云南省昆明市650011

出　　处：《中国组织工程研究与临床康复》2009年第31期6045-6049,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：云南省科技厅社会发展项目基金资助(2007CA007)~~

摘　　要：背景:肝脏移植后胆道狭窄是严重影响肝移植后患者生存和生活质量的重要因素。目的:探讨和分析肝移植后胆道狭窄的病因及处理。设计、时间及地点:回顾性病例分析,于2006-05/2008-09在昆明医学院附属昆明市第一人民医院及云南省器官移植研究所肝移植研究中心完成。对象:90例临床肝脏移植患者,男67例,女23例,年龄2～68岁。供肝选择:尸体供肝72例,活体供肝18例,供受者ABO血型不合2例。方法:经典式原位肝脏移植1例,其余均为改良背驮式原位肝脏移植。胆道重建术中6例采用胆总管或右/左肝管(活体肝移植)空肠吻合术,84例胆总管-胆总管端端吻合术,其中5例供受体胆管不匹配者放置T型管。吻合采用可吸收缝线或6-0Proline线,前、后壁连续缝合。术后应用他克莫司胶囊、霉酚酸酯及皮质激素组成的三联免疫抑制方案预防排斥反应,逐步转为他克莫司胶囊、皮质激素二联方案。主要观察指标:患者术后胆道狭窄发生情况及病情转归。结果:90例肝移植患者中有8例发生胆道狭窄并发症,其中吻合口狭窄5例,非吻合口狭窄3例。吻合口狭窄中有3例炎性水肿引起狭窄者经逆行经胰肝胆管造影球囊扩张或置入胆道支架治疗后痊愈。2例因吻合口胆漏瘢痕收缩导致狭窄者经逆行经胰肝胆管造影置入胆道塑料支架,1例狭窄消失,1例好转;3例非吻合口狭窄者均为弥漫性肝内胆管狭窄者,经逆行经胰肝胆管造影或经皮肝胆管造影采用球囊扩张和胆道支架置入治疗,效果不佳,2例行二次肝脏移植后获救,1例无效死亡。结论:吻合口狭窄和非吻合口狭窄两种病因在治疗方式及结果中存在差异,故肝移植术后胆道狭窄的的鉴别尤为重要。只要从术前、术中、术后多途径、多措施全方位进行联合预防,严密监护,及时发现和采取适当的治疗措施,将有效地预防和减少肝移植术后胆道狭窄的发�BACKGROUND： Biliary stricture following orthotopic liver transplantation （OLT） affects the living pattern of patients. OBJECTIVE： To explore causes and treatment of biliary stricture following OLT. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the First People＇s Hospital Affiliated to Kunming Medical College, Liver Transplantation Center of Organ Transplantation Institute of Yunnan Province between May 2006 and September 2008. PARTICIPANTS： Ninety patients receiving liver transplantation. There were 67 males and 23 females, ranging in age from 2 to 68 years. The donor livers were selected form 72 cadavers and 18 living donors, 2 donor-recipients with ABO-incompatible. METHODS： One case received classical OLT, the others were performed modified piggyback OLT. In biliary passage reconstruction, 6 cases adopt common bile duct or right/left hepatic duct （living donor liver transplantation） jejunum anastomosis, 84 cases of common bile duct-choledochocholedochostomy, including 5 cases implanted T-tube who had mismatch bile duct with donators. The incision was continuous sutured through anterior and posterior walls with 6-0Prolene thread. The triple immunosuppressive regimen （contains tacrolimus, mycophenolate and adrenal cortex hormone） was used to prevent reject reaction after operation, and then gradually changed to using tacrolimus and adrenal cortex hormone. MAIN OUTCOME MEASURES： The stricture occurrence and prognosis of patients after operation. RESULTS： There were 8 cases of biliary stricture in 90 cases, including 5 cases of anastomotic biliary stricture （ABS） and 3 cases of non-anastomotic biliary stricture （NABS）. Among the cases with ABS, 3 cases were caused by inflammatory edema and cured by balloon dilatation combined with biliary stent implantation. Two cases suffered from scar contracture stricture, stenosis lesions disappeared and 1 improved after biliary stent implantation. Among the cases with non-anastomotic biliary stricture, 2 cases rec

关 键 词：肝脏移植术 吻合口狭窄 非吻合口狭窄 

分 类 号：R617[医药卫生—外科学]