肝移植术后非吻合口胆管狭窄相关危险因素的研究

目的　探讨肝移植术后非吻合口胆管狭窄 (NABS)的相关危险因素。方法　回顾性分析了我院自 1998～ 2 0 0 1年的肝移植病例 80例。结果　 80例病人中 ,发生NABS 17例 ,存在肝动脉并发症 (hepaticarterycomplication ,HAC) 15例、巨细胞病毒PP6 5 (CMVPP6 5 )阳性者 19例。与无NABS病人相比 ,NABS组门脉阻断时间 (portalveininterrupt,PVI)明显延长 ,具有显著性差异 (t=- 4 4 90 ,P <0 0 1)。而年龄、冷保存时间无明显差异。按有无HAC、CMVPP6 5阳性将病例分组 ,发现CMVPP6 5阳性组NABS发生显著增高 (χ2 =14 6 6 4 ,P <0 0 1)。本文涉及的HAC的发生在NABS与非NABS病人中未见明显差异。结论　门静脉阻断时间、CMVPP6 5阳性被认为是我院NABS发生的危险因素。手术引起胆总管供血的改变 ,免疫损伤对NABS发生有影响。尚不能排除肝动脉并发症对NABS发生的影响 ,尤其可能存在肝动脉变异分支及细小分支的缺失对NABS发生的影响。

Identification of risk factors associated with nonanastomatic biliary stricture after liver transplantation

Objective To investigate the risk factors of nonanastomatic biliary stricture (NABS) after liver transplantation. Methods The clinical data of 80 patients receiving orthotopic liver transplantation (OLT) in our hospital between 1998 and 2001 were retrospectively analyzed. Results Of the 80 patients, 17 were with NABS, 15 with hepatic artery complication (HAC) and 19 were CMV-pp65 positive. The portal vein interrupt time (PVI) was significantly longer in patients with NABS than in those without (P<0.01). No differences were found in age and cold ischemia time (CIT). NABS was significantly higher in the patients with CMV-pp65 positivity than in those without (P<0.01). No significant difference in occurring rate was found the patients with NABS and those without. Conclusions The PVI and CMV-pp65 positivity are risk factors of NABS in our hospital. The intraoperative blood supply change of the bile duct and immune injury can affect NABS. The effect of HAC on NABS can not be excluded. In particular, hepatic artery aberrance and small artery branch defect may possibly affect NABS.