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活体右半肝移植术中胆道开口数目及重建方式与术后胆道并发症相关分析

赵冰清1,高伟2,朱志军3,3,孙丽莹3,曾志贵4   

  1. 1. 天津医科大学一中心临床学院
    2. 天津市第一中心医院
    3. 北京友谊医院外科楼11楼肝移植办公室
    4.
  • 收稿日期:2012-09-25 修回日期:2012-11-22 出版日期:2013-04-15 发布日期:2013-04-15
  • 通讯作者: 赵冰清

The analysis of the relationship between graft’s biliary orifice numbers and related complications in right lobe living donor liver transplantation

  • Received:2012-09-25 Revised:2012-11-22 Published:2013-04-15 Online:2013-04-15

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摘要：

【摘要】目的 探讨活体右半肝移植术中移植肝胆道开口数目及重建方式与受体胆道并发症的关系及其防治措施。方法 回顾性分析94例成人间活体肝移植资料，根据供肝断面胆道开口数目不同进行分类，比较活体右半肝移植术后胆道并发症发生情况。结果 移植肝断面胆道开口数为1个的有63例，开口数为2个的有30例，开口数目为3个的有1例。肝移植受体术后胆道并发症总发生率为35.1%（33/94），其中胆漏为6.4%(6/94)，吻合口狭窄为29.8% (28/94)，非吻合口胆管狭窄为2.1%(2/94)。供肝断面胆道开口数目为1个的胆道并发症发生率低于多个开口者（P< 0.05）。2例胆漏患者经再次手术治疗，20例患者经胆汁引流结合药物等保守治疗，11例行T管窦道放置支撑管或内镜逆行胰胆管造影下球囊扩张治疗。所有患者病情均得到改善，肝功能好转。结论 活体右半肝移植术供肝切取过程中，在确保供者安全的前提下，尽可能获得单一胆道开口的移植物有利于减少术后胆道并发症的发生；胆汁引流结合药物、内镜及放射介入技术是治疗胆道并发症的有效手段。

关键词: 肝移植, 活体供者, 胆道开口, 胆道重建, 胆道并发症

Abstract: 【Abstract】 Objective To investigate the correlation between the number of biliary orifices and biliary complications, and to explore the preventive and curative methods for biliary complications. Methods Materials of 94 living donor liver transplantations were retrospectively analyzed. According to the various numbers of biliary orifices, we reviewed the incidence of biliary complications in all recipients. Results 63 grafts had one biliary orifice, 30 had two biliary orifices and 1 had three. Total incidence of biliary complications was 35.1%（33/94）, including bile leakage(6.4%) and biliary stricture(31.9%). The rate of biliary complication was significantly different between single biliary orifice group and multiple (P=0.02). Two patients suffering from bile leakage reoperated, four were cured through conservative treatment like drugs and bile drainage. 18 patients suffering from biliary anastomotic stoma stricture were cured through drugs, T-tube or ENBD drainage. The other ten patients were treated by bile drainage and placing stent through T-tube or endoscopic retrograde cholangioplasty. 1 non-anastomotic stoma stricture patient were treated by placing stent through T-tube. The other were cured through ENBD drainage. The liver function of all patients got better. Conclusion Under the premise of ensuring the safety of donors, harvesting single bile duct stump is considerable as far as possible, which can reduce biliary complication effectively. Bile drainage and radiate intervention treatment are effective for treatment of biliary complications.