胆管空肠吻合术重建胆道对肝移植患者术后胆道并发症的影响  

Impact of bile duct reconstructing by Roux-en-Y choledochojejunostomy to patients with biliary complications after liver transplantation

作　　者：汪根树[1] 李华[1] 姜楠[1] 许赤[1] 杨建旭[1] 李势辉[1] 易述红[1] 张剑[1] 杨扬[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝脏移植中心中山大学器官移植研究所广东省器官移植中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2012年第3期34-38,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家重点基础研究发展规划项目(973分课题)(2009CB522404);广东省科技计划项目(2011B060300002)

摘　　要：目的探讨肝移植术中采用胆管空肠吻合术重建胆道对患者术后胆道并发症发生的影响。方法本组回顾性研究对象为2003年10月至2009年7月在中山大学附属第三医院肝移植中心实施原位肝移植术的765例患者。患者均签署知情同意书,符合医学伦理学规定。按胆道重建方式将患者分为胆管空肠吻合术组(胆肠吻合组)52例和胆管端端吻合术组(端端吻合组)713例。统计两组肝移植术后胆漏、胆管狭窄及胆泥或结石等胆道并发症发生率。采用χ2检验比较两组胆道并发症发生率。结果本组765例肝移植术后患者共有132例发生胆道并发症,术后胆道并发症总的发生率为17.3%(132/765),胆漏、胆管狭窄和胆泥或结石的发生率分别为2.4%(18/765)、16.3%(125/765)和4.6%(35/765)。胆肠吻合组胆漏、胆管狭窄和胆泥或结石的发生率分别为6%(3/52)、21%(11/52)和8%(4/52),端端吻合组分别相应为2%(15/713)、16%(114/713)和4%(31/713)。两组患者术后胆漏、胆管狭窄和胆泥或结石的发生率比较,差异无统计学意义(均为P>0.05)。两组吻合口狭窄和非吻合口狭窄比例比较差异亦无统计学意义(χ2=0.374、2.661,均为P>0.05)。结论与胆管端端吻合术比较,肝移植患者术中采用胆管空肠吻合术并未增加术后胆道并发症发生率,两种术式均为胆道重建的有效方法,胆肠吻合术可以作为胆管端端吻合术的有益补充。Objective To investigate the impact of reconstructing bile duct by Roux-en-Y choledochojejunostomy during liver transplantation on postoperative biliary complications. Methods This retrospective study included 765 patients who underwent orthotopic liver transplant at the Liver Transplantation Center of the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to July 2009. Local ethical committee approval was received and that the informed consent of all participating subjects was obtained. According to the bile duct reconstruction techniques, the patients were divided into 2 groups with 713 patients receiving duct-to-duct choledochocholedochostomy and 52 patients of Roux-en-Y choledochojejunostomy. The overall incidences of biliary complications such as bile leakage, biliary stricture and lithiasis/sludge were compared by ）（z test. Results One-hundred and thirty-two of the 765 patients suffered biliary complications. The overall morbility of biliary complications including bile leakage, biliary stricture as well as biliary lithiasis/sludge were 17.3%（132/765）, 2.4%（18/765）, 16.3%（125/765） and 4.6% （35/765） respectively. The incidences of bile leakage, biliary stricture and lithiasis/sludge were 6% （3/52）, 21%（11/52） and 8%（4/52） respectively in the patients with Roux-en-Y hepaticojejunostomy, and 2%（15/ 713）, 16% （114/713） and 4% （31/713） respectively in the patients with duct-to-duct choledochocholedochostomy. There was no significant difference between 2 groups （all in P〉0.05）. The proportions of anastomotic strictures and non anastomotic strictures between 2 groups demonstrated no significant difference （X^2=0.374, 2.661; all in P〉0.05）. Conclusions Compared with the duct-to-duct choledochocholedochostomy, Roux-en-Y choledochojejunostomy during liver transplantation does not increase the incidence of postoperative biliary complications. Both techniques are effective in reconstructing bile duct. Roux-en-Y choledochojejunostomy is a useful

关 键 词：肝移植术 胆管端端吻合术 胆管空肠吻合术 胆道并发症 

分 类 号：R657.4[医药卫生—外科学]