降低肝移植术后手术技术相关胆道并发症的体会

目的 探讨肝移植的手术技巧，以降低手术相关胆道并发症。方法 对89例终末期肝病患者施行腔静脉成形的改良背驮式原位肝移植，供肝肝总动脉与受者肝总动脉端端吻合，供肝肝总管或胆总管与受者胆总管端端吻合，未置T管。术后定期进行影像学检查，了解移植肝是否出现胆道并发症。结果 1例术后5个月发生肝门分叉处胆管狭窄，经球囊扩张后效果不佳，再次手术行胆管狭窄成形术后治愈；其余患者未发生胆漏、吻合口狭窄、胆泥或胆道结石、肝门部胆管狭窄、胆管炎、胆汁瘤、粘液囊肿及十二指肠乳头功能异常等胆道并发症。结论 注重供肝的灌洗和修整，提高肝动脉吻合和胆道重建技巧，可有效避免或减少技术性胆道并发症的发生。

Experience to decrease surgical biliary complications of liver transplantation

Objective To evaluate skills to avoid or decrease surgical biliary complications of liver transplantation. Methods Eighty-nine cases received modified piggyback liver transplantation, and the operative skills included preserved blood supply of exhepatic biliary duct, end to end common hepatic artery anastomosis of donor and recipient, end to end common biliary duct anastomosis without placement of T tube. Imagine checks were done periodically. Results Stenosis of hepatic hillar bifurcation occurred in on patient and biliary ductoplasty was performed, and the remaining patients had no biliary duct complications. Conclusions Comprehensive application of surgical skills including preserved blood supply of donor liver biliary duct, end to end anastomosis of common hepatic artery and common hepatic/biliary duct to common biliary duct can avoid or decrease the biliary duct complications of liver transplantation related to operation.