儿童劈离式肝移植的胆管分型与重建  

Classification and reconstruction of bile duct in pediatric split liver transplantation

作　　者：韦金铭 冯啸[1] 曾凯宁[1] 杨卿[1] 姚嘉[1] 傅斌生[1] 张彤[1] 黄心如 刘博颖 陈规划[1] 杨扬[1] 易述红[1] Wei Jinming;Feng Xiao;Zeng Kaining;Yang Qing;Yao Jia;Fu Binsheng;Zhang Tong;Huang Xinru;Liu Boying;Chen Guihua;Yang Yang;Yi Shuhong(Department of Liver Transplantation,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《器官移植》2022年第6期791-796,共6页Organ Transplantation

基　　金：广东省自然科学基金(2020A1515010574)。

摘　　要：目的探讨儿童劈离式肝移植左肝内胆管(LHD)的解剖分型、胆道重建方式及其与术后胆道并发症的关系。方法回顾性分析75例儿童劈离式肝移植受者的临床资料。供肝劈离前采用碘普罗胺注射液经胆总管逆行造影,根据二、三、四段肝内胆管走向确定供肝LHD的解剖分型,总结不同LHD分型的胆道重建方案,分析儿童劈离式肝移植术后胆道并发症的发生及治疗情况。结果75个供肝中,LHD解剖分型为Ⅰ型57例(76%)、Ⅱ型9例(12%)、Ⅲ型4例(5%)、Ⅳ型5例(7%)。75例儿童受者的胆道重建方案包括左肝管-空肠Rouxen-Y吻合69例(Ⅰ型53例、Ⅱ型8例、Ⅲ型4例、Ⅳ型4例),胆总管-空肠Roux-en-Y吻合1例(Ⅳ型),左肝管-胆总管端端吻合5例(Ⅰ型4例、Ⅱ型1例)。术后6例发生胆道并发症,发生率为8%,其中胆道吻合口狭窄3例,胆道吻合口胆漏2例,肝断面胆漏1例。发生在Ⅰ型4例,发生在Ⅲ型2例,LHD经典型与解剖变异型的胆道并发症发生率差异无统计学意义(均为P>0.05)。3例胆道吻合口狭窄受者中,2例行经皮经肝胆道引流术(PTCD),1例行再次胆肠吻合术;2例胆道吻合口胆漏受者均行PTCD;1例断面胆漏受者予局部引流。6例患儿治疗后均存活。结论供肝中24%存在LHD的解剖变异,其中Ⅱ型最多,为12%。供肝劈离前常规胆道造影和精细的胆道吻合技术可以有效降低胆道并发症的发生率。术后胆道并发症的发生与LHD解剖分型无明显相关性。Objective To investigate the anatomical classification of left intrahepatic bile duct(LHD)and the pattern of bile duct reconstruction during pediatric split liver transplantation and their relationship with postoperative biliary complications.Methods Clinical data of 75 pediatric recipients undergoing split liver transplantation were analyzed retrospectively.Before splitting the donor liver,iopromide injection was used for retrograde cholangiography through the common bile duct.According to the patterns of intrahepatic bile ducts in the second,third and fourth segments,the anatomical classification of LHD of the donor liver was determined.The biliary reconstruction regimens for different classification types of LHD were summarized.The incidence and treatment of biliary complications after pediatric split liver transplantation were analyzed.Results Among 75 donor livers,the anatomical classification of LHD included 57 cases(76%)of typeⅠ,9 cases(12%)of typeⅡ,4 cases(5%)of typeⅢand 5 cases(7%)of typeⅣLHD,respectively.Among 75 pediatric recipients,69 cases(53 cases of typeⅠ,8 typeⅡ,4 typeⅢand 4 typeⅣ)underwent the left hepatic duct-jejunum Roux-en-Y anastomosis,1 case received common bile duct-jejunum Roux-en-Y anastomosis(typeⅣ),and 5 cases underwent the left hepatic duct-common bile duct end-to-end anastomosis(4 cases of typeⅠand 1 typeⅡ).Postoperative biliary complications occurred in 6 cases(8%),including 3 cases of biliary anastomotic stenosis,2 cases of biliary anastomotic leakage and 1 case of bile leakage on the hepatic resection surface.Among 6 recipients,4 cases were classified as typeⅠand 2 cases of typeⅢLHD.No significant difference was observed in the incidence of biliary complications between typical type and anatomical variant type of LHD(all P>0.05).Among 3 recipients with biliary anastomotic stenosis,2 cases underwent percutaneous transhepatic cholangial and drainage(PTCD)and 1 case repeatedly received biliary-intestinal anastomosis.Two cases of biliary anastomotic leakage u

关 键 词：劈离式肝移植 儿童 左肝内胆管 解剖分型 胆道造影 胆道重建 胆道吻合口狭窄 胆漏 

分 类 号：R617[医药卫生—外科学] R575[医药卫生—临床医学]