术中放置内支架管预防肝移植胆道吻合口并发症  

Intraoperativeinternal stenting for preventing biliary anastomotic complications of liver transplantation

作　　者：蔡庆 霍枫 陈建雄 季茹 郑于剑 张宝 Cai Qing;Huo Feng;Chen Jianxiong;Ji Ru;Zheng Yujian;Zhang Bao(Department of Hepatobiliary Surgery and LiverTransplantation Center,General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院肝胆外科肝移植中心,广州510010

出　　处：《中华器官移植杂志》2021年第10期582-586,共5页Chinese Journal of Organ Transplantation

基　　金：广东省基础与应用技术研究基金项目(2020A1515010557);广州市科技计划项目(202002030201)。

摘　　要：目的探讨原位肝移植复杂胆道端端重建术中放置内支架管在预防胆道吻合口并发症中的作用。方法2018年12月1日至2020年4月30日在解放军南部战区总医院6例肝移植受者复杂胆道重建过程放置胆道内支架管,观察术后病情转归、胆红素和胆道酶学恢复、术后胆道内支架管处理及术后胆道并发症发生等情况。结果6例受者均顺利康复出院,出院前胆红素及胆道酶学均恢复正常。术后血清总胆红素、碱性磷酸酶、γ-谷氨酰转肽酶、总胆汁酸等指标峰值分别为(83.8±56.4)μmol/L、(151.5±76.3)U/L、(301.7±177.0)U/L、(98.4±80.9)μmol/L,出现拐点时间分别为术后(2.3±1.0)d、(3.0±1.1)d、(3.8±1.2)d、(1.8±0.8)d,指标恢复至正常时间分别为术后(7.7±5.1)d、(5.0±4.9)d、(23.5±7.6)d、(3.8±2.4)d。中位随访时间13.5个月,3例受者术后通过十二指肠镜拔除胆道内支架管,3例术后胆道内支架管自行脱落。除1例受者术后1年出现无症状的吻合口狭窄外,其余受者随访期间均未出现胆道并发症。结论在肝移植复杂胆道重建过程放置胆道内支架管,可以有效促进术后肝功能恢复,改善受者生活质量,有效避免肝移植术后胆道吻合口并发症的发生,保障受者安全。Objective To explore the role of internal stenting for preventing biliary anastomotic complications during complex duct-to-duct biliary reconstruction of orthotopic liver transplantation.Methods From December 1,2018 to April 30,2020,intraductal stent was placed in 6 cases of complex biliary tract reconstruction during liver transplantation.Postoperative prognosis,recovery of bilirubin and biliary enzymes,management of intraductal stent and occurrence of postoperative biliary complications were observed.Results All of them recovered and were discharged smoothly and bilirubin and biliary enzymes normalized before discharge.The average peak values of total bilirubin,alkaline phosphatase,total bile acid andγ-glutamyl transpeptidase were 83.8±56.4μmol/L,151.5±76.3 U/L,301.7±177.0 U/L and 98.4±80.9μmol/L and the average turning points of total bilirubin,alkaline phosphatase,total bile acid andγ-glutamyl transpeptidase 2.3±1.0,3.0±1.1,3.8±1.2 and 1.8±0.8 days;average time of complete recovery of total bilirubin,alkaline phosphatase,total bile acid andγ-glutamyl transpeptidase 7.7±5.1,5.0±4.9,23.5±7.6 and 3.8±2.4 days respectively.Intraductal stent was removed by gastroduodenoscopy(n=3)and slipped off(n=3).Except for one case of asymptomatic anastomotic stricture at 1 year post-operation,no biliary complications occurred during follow-ups.Conclusions The placement of intraductal stent during complex biliary reconstruction of liver transplantation can effectively promote the recovery of postoperative liver function,enhance the quality-of-life of patients,effectively avoid the occurrence of biliary anastomotic complications and ensure the safety of patients.

关 键 词：肝移植 胆道 支架 

分 类 号：R657.3[医药卫生—外科学]