胆管空肠吻合术在肝移植术后肝外胆道并发症治疗中的应用价值  

Application value of Roux-en-Y choledochojejunostomy in the treatment of extrahepatic biliary complications after liver transplantation

作　　者：李华[1] 汪根树[1] 傅斌生[1] 张彤[1] 朱曙光[1] 吴小材[1] 张剑[1] 杨杨[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39-42,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家"973"项目(2009CB522404);国家自然科学基金(30772135);国家自然科学基金(81172038);广东省科技计划项目(2009B030801078)

摘　　要：目的探讨胆管空肠Roux-en-Y吻合术(胆肠吻合术)在肝移植肝外术后胆道并发症治疗中的作用。方法本回顾性研究对象为2003年3月至2008年3月在中山大学附属第三医院行原位肝移植(OLT),术后发生胆道并发症的109例患者。患者均签署知情同意书,符合医学伦理学规定。按照肝移植术后胆道并发症治疗方法不同分为胆肠吻合组(40例)和非胆肠吻合组(69例)。胆肠吻合组男性31例,女性9例,年龄25～69岁,中位年龄47岁;胆漏4例、胆道狭窄31例、胆泥或结石形成5例。非胆肠吻合组男性56例,女性13例,年龄31～59岁,中位年龄45岁;胆漏3例、胆道狭窄41例、胆管炎19例、胆泥或结石形成6例;首次肝移植术中胆道重建方式均采用供肝胆管￣受体胆管端端吻合术。胆肠吻合组患者均行胆肠吻合术,非胆肠吻合组治疗方法包括内镜下逆行性胰胆管造影术(ERCP)鼻胆管引流、经皮经肝穿刺胆道引流术(PTCD)、胆道介入放置支架、肝动脉放置支架。患者接受随访。观察两组死亡发生情况、胆道并发症的治疗情况、治疗后患者的术后胆道感染发生率,比较采用χ2检验。结果所有患者均接受随访,随访时间6～24个月,中位随访时间15个月。胆肠吻合组无发生死亡,非胆肠吻合组发生死亡4例,均死于术后严重的胆道感染及合并其他器官感染。胆肠吻合组的胆道并发症明显好转率为78%(31/40),非胆肠吻合组明显好转率为70%(48/69);胆肠吻合组胆道并发症的明显好转率显著高于非胆肠吻合组(χ2=32.517,P<0.01)。胆肠吻合组的胆道感染发生率61%(19/31),非胆肠吻合组为63%(30/48),两组比较差异无统计学意义(χ2=0.060,P>0.05)。结论胆肠吻合术能有效改善肝移植术后肝外胆道并发症的临床症状,在治疗肝移植术后胆道并发症方面有一定应用价值。Objective To explore the role of Roux-en-Y choledochojejunostomy in the treatment of extrahepatie biliary complications after liver transplantation. Methods Clinical data of 109 patients suffered biliary complications after orthotopic liver transplantation （OLT） in the Third Affiliated Hospital of Sun Yat-Sen University, from March 2003 to March 2008 were analyzed retrospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. All the patients were divided into the Roux-en-Y group and non-Roux-en-Y group, according to the different treatment of biliary complications after LT. There were 31 males and 9 females in the Roux-en-Y group （age ranging from 25-69, median age of 47）, including 4 cases of bile leakage, 31 cases of biliary stricture and 5 cases of biliary sludge or stones. There were 56 males and 13 females in the non-Roux-en-Y group （age ranging from 31-59, median age of 45）, including 3 cases of bile leakage, 41 cases of biliary stricture, 19 cases of cholangitis and 6 cases of biliary stones or sludge. Duct-to-Duct anastomosis was performed to reconstruct the biliary tract in the primary liver transplantation. Patients in the Roux-en-Y group received Roux-en-Y choledochojejunostomy, while the patients in the non-Roux-en-Y group underwent one of the following operations such as endoscopic retrograde cholangiopancreatography （ERCP） and nasobiliary drainage, percutaneous transhepatic cholangial drainage（PTCD）, hepatic artery stents as well as biliary stents. The patients were followed up. The mortality, treatment outcome of biliary complications, mortality of biliary infection of all patients in two groups were observed and compared by chi-square test. Results All the patients were followed up for 6-24 months（median：15 months）. No death was observed in the Roux-en-Y group and 4 cases in the non-Roux-en-Y group died of severe bilial3, infection after liver transplantation and/or other organ infections. The

关 键 词：肝移植 肝外胆道并发症 胆肠吻合术 介入治疗 胆道感染 

分 类 号：R657.4[医药卫生—外科学]