联合肝门板的肝门￣空肠吻合术治疗肝移植术后缺血型胆道病变患者  

Roux-en-Y hepatojejunostomy combined with hilar plate in the treatment of ischemic-type biliary lesion after liver transplantation

作　　者：易述红[1,2] 易慧敏[1,2] 傅斌生[1,2] 孟炜[1,2] 李华[1,2] 许赤[1,2] 杨扬[1,2] 陈规划[1,2] 

机构地区：[1]中山大学附属第三医院肝移植中心 [2]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》2013年第1期13-16,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2012010009333);广东省科技计划项目基金(2011B031800060);广州市科技计划重大民生专项基金(2011Y1-00033-2);中山大学医学基金(10ykjc03)

摘　　要：目的探讨联合肝门板的肝门￣空肠吻合术治疗肝移植术后缺血型胆道病变(ITBL)患者的疗效。方法回顾性分析2008年10月至2009年12月中山大学附属第三医院肝移植中心先后收治的3例ITBL患者的临床资料。男2例,女1例,年龄分别为24、34、36岁,中位年龄34岁。患者均签署知情同意书,符合医学伦理学规定。3例患者发病时间分别为肝移植术后14个月(例1)、3年(例2)、18个月(例3),均以梗阻性黄疸为主要症状,ITBL主要位于左右肝管及其汇合部(局限于肝门部)。采用联合肝门板的肝门￣空肠吻合术。观察3例患者手术及术后并发症等。出院后患者接受定期随访,观察患者预后情况。结果 3例患者手术均成功,术后恢复顺利,无发生胆漏和肠漏等手术相关并发症。例1患者由于肝内胆道缺血型胆道病变进展,在术后病情稳定2年9个月后再次出现ITBL临床表现,拟行再次肝移植;例2患者术后随访3年情况稳定;例3患者术后病情稳定6个月后再次出现严重的ITBL表现,放弃治疗。结论联合肝门板的肝门￣空肠吻合术可用于治疗局限于肝门部且病情稳定的ITBL患者,可延缓或避免再次肝移植手术。Objective To investigate the efficacy of Roux-en-Y hepatojejunostomy combined with bilar plate in the treatment of iscbemic-type biliary lesion （ITBL） after liver transplantation. Methods Clinical data of 3 patients with ITBL （2 males and 1 females; 24-, 34-, 36 years of age; 34 years of mean age） successively admitted in the Third Affiliated Hospital of Sun Yat-Sen University from October 2008 to December 2009 were analyzed retrospectively. All Patients signed the informed consent and the ethics committee approval was recieved. The 3 patients, with the main symptoms of obstructive jaundice, developed ITBL at 14 months（Case 1）, 3 years （Case 2） and 18 months （Case 3） after liver transplantation respectively. Ischemic bile duct lesions mainly located the left and fight hepatic duct and confluence （limited in the hepatic hilar）. Roux-en-Y hepatojejunostomy combined with hilar plate was performed on these 3 patients. The patients received regular follow-up visits after discharge. The intraoperative, postoperative complications and prognosis were observed. Results The operations were successful and all the 3 patients recovered well. No surgery-related complications such as bile leakage, intestinal leakage were found. Case 1 suffered ITBL 2 years and 9 months later due to ischemic intrahepatic biliary tract lesions progress and planned to undergo liver retransplantation. Case 2 was followed for 3 years and in stable condition. Case 3 gave up treatment for serious ITBL 6 months later. Conclusions Roux-en-Y hepatojejunostomy combined with hilar plate offers a good therapeutic alternative for ITBL when the lesions are limited in the hepatic hilar. It could postpone or avoid liver retransplantation.

关 键 词：肝移植 手术后并发症 胆道疾病 胆肠吻合术 肝门板 

分 类 号：R657.3[医药卫生—外科学]