肝移植术后并发高位胆管狭窄的原因及诊治八例

目的 探讨原位肝移植术后并发高位胆管狭窄的原因及诊治.方法 对8例肝移植后并发高位胆管狭窄患者的资料进行回顾性分析,8例均行背驮式肝移植,胆管采取端端吻合,其中2例置婴儿胃管.结果 高位胆管狭窄发生于术后3～18个月,5例以阻塞性黄疸为主要临床表现,3例以慢性胆管炎为主要临床表现.经保守治疗无效后,均行手术治疗,切除肝门部胆管狭窄段,再行胆肠Roux-en-Y吻合术.手术治疗后随访1～5年,除1例患者因肝癌复发死亡外,其余患者均生存良好.结论 胆道缺血、胆汁腐蚀以及保存性损伤是并发高位胆管狭窄的主要因素;B型超声波和磁共振胰胆管成像是有效诊断手段;胆肠Roux-en-Y吻合是处理高位胆管狭窄的有效方法.

Analysis of the etiology,diagnosis and management of 8 cases of hepatic hilar biliary stricture following orthotopic liver transplantation

Objective To explore the etiology,diagnosis and management of hepatic hilar biliary stricture tollowing orthotopic liver transplantation.Methods 291 cases received orthotopic liver transplantation in our hospital from Jan.1996 tO Dec.2006.The clinical data of 8 patients with hepatic hilar biliary stricture following orthotopic liver transplantation in this term were analyzed retrospectively.Results The interval between the transplantation and the occurrence of hepatic hilar biliary stricture was ranged from 3 to 18 months.Obstructive jaundice and/or repeated biliary inflaHlmation were the cardinal symptom of hepatic hilar biliary stricture.Ultrasound was a good imaging tool for diagnosing hepatic hilar biliary stricture after liver transplantation.MRCP was an accurate imaging tool for fixing the position of hepatic hilar biliary stricture.All 8 cases were managed through surgical operation,through which cramped bile duct was incised and bile duct reconstruction was performed through Koux-en-Y bile duct and intestine anastomosis.The mean follow-up period was 1-5 years.One case died of liver cancer,and others were cured.Conclusion The occurrence of hepatic hilar biliarv stricture following orthotopic liver transplantation is mainly due to insufficient blood supply to the bile duct,bile corrosion and ischemia reperfusion injury.Biliary duct reconstruction performed through Roux-en-Y bile duct and intestine anastomosis is a most effective mcthod.