成人右半肝活体肝移植胆道重建探讨  

Biliary reconstruction in adult-adult living donor liver transplantation using a right lobe graft

作　　者：林栋栋[1] 卢实春[1] 李宁[1] 王孟龙[1] 张振[1] 伏志[1] 郭庆良[1] 张毅[1] 李传云[1] 赖威[1] 朱岳[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝胆外科暨肝脏移植中心,100069

出　　处：《中华肝胆外科杂志》2011年第8期627-630,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家自然科学基金资助（30671977）

摘　　要：目的 探讨成人右半肝活体肝移植胆道重建的技术问题。方法 回顾性分析我院2007年4月至2009年5月完成的21例成人右半肝活体肝移植资料。 供肝右肝管与受者肝总管单个吻合10例；供肝两支胆管开口分别与受者两支胆管吻合5例；供肝胆管整形成一个开口与受者胆管吻合5例，其中采用T管支撑2例，Y型管支撑1例；右肝管空肠Roux-en-Y吻合1例。结果 4例受者术后1个月内死亡，1例因术后急性肝坏死行再次肝移植。其余受者存活至今，1年存活率为77.65%。受者术后发生胆道并发症7例，其中胆漏5例，胆道狭窄2例，均经外科手术处理痊愈。胆管与胆管单个吻合口组、胆管整形成一个开口与受者胆管吻合组和两支胆管开口分别与受者胆管吻合组比较，胆道并发症发生率差异无统计学意义（χ2=0.659，P=0.719）。结论 根据供受者胆管情况，可以灵活采用单根胆管吻合、胆管整形、分别吻合和肝管空肠吻合等不同重建方式。后壁连续、前壁间断以及显微外科技术的采用可能有助于降低胆道并发症的发生率。Objective To review the techniques used in biliary reconstruction for adult-adult living donor liver transplantation using a right lobe graft. Methods The clinical data of 21 pairs of donor and recipient who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing Youan Hospital were analyzed retrospectively. Biliary anastomoses consisted of 10 single right hepatic duct to common hepatic duct anastomoses, 5 donor double branched ducts to recipient double branched ducts anastomoses, 5 single anastomoses between a donor double branched duct which had been converted to a single duct by ductoplasty to a single recipient bile duct, and 1 hepaticojejunostomy. A T-tube was inserted through the anterior wall of the common hepatic duct and splinted across the anastomosis in 2 recipients and a Y-tube was used in 1 recipient. Results 4 recipients died during the first post-transplant month. Another recipient received a retransplantation for acute liver necrosis. The remaining recipients were alive. The 1-year survival rate of the recipients was 77.65%. 5 patients developed biliary leakage and 2 patients developed biliary stricture. The 7 biliary complications were treated and cured by further surgical procedures. There was no significant difference in the biliary complications among the three different types of biliary anastomotic groups （χ2=0.659, P=0.719）. Conclusion The different types of biliary anastomoses can be used in living donor liver transplantation depending on the situations found in the donors and recipients. Continuous suturing on the posterior wall of the bile duct, interrupted suturing on the anterior wall and microsurgical techniques in biliary reconstruction are effective modalities to minimize biliary complications.

关 键 词：肝移植 活体供者 右半肝 胆道重建 

分 类 号：R657.3[医药卫生—外科学]