原位肝移植术后胆道并发症的预防和治疗(附43例肝移植报告)

目的：探讨原位肝移植术后胆道并发症的防治。方法：回顾性分析2001年10月至2003年3月的43例原位肝移植的临床资料。结果：本组43例行原位肝移植术的病人中，6例发生了胆道并发症，发生率为13．95％；计胆道狭窄3例，拔T管时胆漏2例，胆总管漏1例。前25例用UW液冲洗胆道，有5例发生胆道并发症．发生率为20．00％．后18例先用林格液彻底冲洗胆道，再用UW液灌注保存，仅1例发生胆道并发症，发生率为5．56％。留置T管的18例病人中3例发生胆道并发症，未放T管的25例中也有3例发生胆道并发症，发生率分别为16．67％和12．00％。6例胆道并发症病人中仅1例实施再次手术，1例死于严重的肺部感染，其余经PTCD充分引流、放射介入和(或)内镜气囊扩张并放置支架等治疗，均取得了满意疗效。结论：在切取供体早期用林格液彻底冲洗胆道系统，是降低胆道并发症的一种有效方法；是否放置T管取决于胆道两端口径的匹配情况和手术医生吻合技术的熟练程度，T管至少宜放置4个月；而胆道并发症的治疗大多可经非手术治愈。

Prevention and Management of Biliary Complication Following Othotopic Liver Transplantation

Objective: To investigate the prevention and treatment of biliary complications following orthotopic liver transplantation(OLT).Methods: The clinical data of 43 patients who underwent orthotopic liver transplantation between October 2001 to March 2003 were studied retrospectively. Results: Postoperative biliary complications occurred in 6 patients, the incidence being 13.95%, including biliary stricture in 3, biliary leakage following extracting the T-tube in 2 and common bile duct leakage in 1. In the first 25 patients, the bile ducts were flushed with UW solution and biliary complications occurred in 5(20.00%), and in the remaining 18 cases, the bile ducts were first flushed thoroughly with Ringer's solution, followed by UW solution instillation and only 1 had biliary complication(5.56%). Three of the 18 cases with T-tube drainage had biliary complications, while out of 25 cases without T-tube drainage, 3 had biliary complications, the incidence being 16.67% and 12.00% respectively. Secondary operation was carried out in only 1 out of 6 patients with biliary complications, another one died of serious pulmonary infection, while the 4 others all recovered satisfactorily with the aid of PTCD flushing, radio-intervention and/or endoscopic air-bladder expansion, and placement of stent. Conclusions: Completely flushing the biliary system with Ringer's solution during the initial period of organ procurement is an efficient method to reduce the occurrence of postoperative biliary complications. Placement of T-tube would depend on the matching of calibers of bile ducts to be anastomosed and the surgeon's skill. The T-tube should be placed for 4 months at least. Most biliary complications could be cured without operation.