肝移植术后胆漏的诊断治疗

目的：探讨肝移植术后胆漏的诊断及治疗方法。方法：回顾分析我院6例肝移植并发胆漏病人（男4例,女2例）的诊断及治疗。胆管重建方式为胆总管端端吻合术。1例为肝脏移植术后第3天T管脱落．1例术后3个月拔除T管后出现胆漏,4例为吻合121漏,其中2例合并胆管狭窄。5例非手术治疗,1例手术治疗。结果：6例胆漏中5例治愈,1例并发感染死亡。结论：术后及时诊断并阻止胆漏．感染恶性循环是治疗胆漏的关键。胆漏多可经非手术治愈。经非手术治疗失败者,应予积极手术治疗。

Diagnosis and management of biliary leakage following orthotopic liver transplantation

Objective To investigate the diagnosis and treatment of biliary leakage following orthotopic liver transplantation(OLT).Methods The clinical data of 6 patients(5 males and 1 female) who developed biliary leakage after OLT were retrospectively analyzed.The common bile ducts were all reconstructed by end-to-end anastomosis.The complications included: early post-operative T tube slipping off in 1 patient;biliary leakage following T tube extracting in 1,and biliary anastomosis leakage in 4,among which 2 cases with concurrent bile duct stricture.Five of these 6 patients were treated successfully conservatively,and 1 patient was submitted to re-operation.Results Five patients were cured and 1 died of severe sepsis.Conclusions Early accurate diagnosis of biliary leakage together with the interruption of the vicious circle of "leakage and infection" is the key point to treat this biliary complication.Most of the biliary leakage cases could be cured conservatively,and operation is recommended in a few cases if the conservative therapy failed.