肝移植术后缺血型胆道病变的病因及防治  

Causes and management of ischemic-type biliary lesion after orthotopic liver transplantation

作　　者：金鑫[1] 史宪杰[1] 王茂强[1] 罗瑜昆 蔡逢春[1] 梁雨荣[1] 罗英[1] 纪文斌[1] 段伟东[1] 董家鸿[1] 

机构地区：[1]中国人民解放军总医院肝胆外科,北京 100853

出　　处：《中华医学杂志》2011年第4期251-255,共5页National Medical Journal of China

摘　　要：目的探讨原位肝移植术后缺血型胆道病变的病因、预防和治疗的措施。方法回顾性地分析自2002年1月至2009年1月间的326例次原位肝移植的临床资料，对23例缺血性胆道病变的治疗经验的总结分析。结果肝移植术后共发生缺血性胆道病变23例（7．05％），其中肝内胆管病变9例，肝外胆管病变12例，肝内外多发胆管病变2例。通过COX比例风险模型分析，重症肝炎（RR：3．204；P=0．014）和冷缺血时间超过11．5h（RR：4．895；P=0．000）是与移植术后发生缺血性胆病相关的独立危险因素。对23例缺血型胆道病变患者依各自特点采用药物、经内镜和放射介入（10例）、外科手术（6例）及再次肝移植（7例）等方法治疗，有效率为73．9％（17／23）。结论针对胆管病变特点选择适宜的治疗方法，是原位肝移植术后ITBL患者获得良好疗效的关键。尽量缩短供肝冷缺血时间和对受体术前仔细评估是预防肝移植术后发生缺血型胆道病变的重要措施。Objective To discuss the causes, diagnosis, prophylaxis and treatment of ischemictype biliary lesions （ITBLs） following orthotopic liver transplantation （OLT）. Methods A retrospective analysis was performed for 326 OLT patients from January 2002 to January 2009. The post-OLT etiological factors and treatment of ITBL cases were analyzed. Results ITBL occurred in 23 patients （ 7.05% ）. It included intrahepatic biliary lesions （n = 9）, extrahepatic lesions （n = 12） and diffuse extrahepatic and intrahepatic biliary lesions （n = 2 ）. Through a COX regression, the risk factors were independently associated with ITBL serious hepatitis as the primary disease（RR：3. 204; P = 0.014）and cold donor ischemie time beyond 11.5 hours （ RR ： 4. 895 ; P = 0. 000 ）. All ITBL patients underwent drug therapy, endoscopy（n = 10）, operation （n = 6） or re-OLT （n = 7） . And improvement was found in 17 patients. Conclusion Avoiding too long old ischemic time of donor liver and carefully evaluating the indications of recipients are effective preventive measures of ITBL. It is crucial to select a proper treatment according to the conditions of each individual Datient.

关 键 词：肝脏移植 胆道并发症 缺血型胆道病变 

分 类 号：R657.3[医药卫生—外科学]