新的保护胆道血供的修肝方法对肝移植术后胆道并发症的影响  

A new graft-preparing technique to protect biliary blood supply and its correlation to biliary complications after liver transplantation

作　　者：梁宾勇 王少发 陈知水 张万广[1] 魏来 蒋继贫 陈栋[2] 张必翔[1] 黄志勇[1] 陈孝平 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科,武汉430030 [2]器官移植研究所/卫生部重点实验室/教育部重点实验室

出　　处：《临床外科杂志》2017年第8期611-614,共4页Journal of Clinical Surgery

基　　金：国家卫计委卫生行业科研专项资助项目(201302009);国家自然科学基金资助项目(81373168);国家重点基础研究发展计划资助项目(973计划)(2013CB530803)

摘　　要：目的探讨新的保护胆道血供的修肝方法对肝移植术后胆道并发症的影响。方法原位肝移植病人97例,分为两组:常规手术病人57例,采用新的保护胆道血供修肝方法的病人40例。观察胆道并发症的发生情况。新的修肝方法的技术要点包括:胃十二指肠动脉根部1 cm不作游离;完全保留胆管周围的组织和格利森鞘;保留胃十二指肠动脉远端变异的肝动脉。结果两组间与胆道并发症相关的危险因素比较,差异无统计学意义,胆道并发症的发生率比较,差异有统计学意义,其发生分别为14.0%(8例)和2.5%(1例)。结论肝移植术后胆道并发症发生率呈下降趋势,但其仍然是肝移植术后最常见的并发症之一。新的保护胆道血供的修肝方法可降低肝移植术后胆道并发症的发生。Objective To explore the effect of a new graft-preparing technique to protect biliary blood supply on biliary complications after liver transplantation. Methods There were 57 cases of routine surgery and 40 cases who adopted the new graft-preparing technique to protect biliary blood supply. There were no statistical differences between the two groups with regard to the risk factors associated with biliary complications. We retrospectively analyze the patients who underwent liver transplantation before and after adopting a new graft-preparing technique to protect biliary blood supply. Biliary complications after liver transplantation were observed mainly. The new graft-preparing technique consists of no isolation of proximal gastroduodenal artery within 1 cm distance,completely preserving the tissue and Glisson sheath around the biliary tract,and harvesting the variant hepatic artery from the distal part of the gastroduodenal artery.Results Significantly,there was statistical difference in the incidence of biliary complications between the two groups. Biliary complications occurred respectively in 8 cases（ 14. 0%） and one case（ 2. 5%） in the routine group and the new technique group. Conclusion Although the incidence of biliary complications after liver transplantation is decreasing,it is still one of the most common complications of liver transplantation. The new method of protecting the blood supply of biliary tract can further reduce the incidence of biliary complications after liver transplantation.

关 键 词：肝移植 并发症 胆管血供 供肝修整 胃十二指肠动脉 

分 类 号：R657.3[医药卫生—外科学]