课题背景：目前认为，肝移植术后胆道并发症的发生与供肝修整、术者吻合技术、供肝冷热缺血时间、缺血再灌注损伤、肝动脉栓塞等有关。课题属于军队“十一五”科技攻关资助课题（06G115），旨在分析肝移植术治疗终末期肝病的临床资料，改良手术技术，对围手术期并发症进行合理治疗，以提高肝移植患者生存率，降低术后并发症发生率。

应用要点：文章回顾性分析解放军总医院第二附属医院全军器官移植中心33例肝移植术后发生胆道并发症患者的临床资料，分析总结了其病因及治疗措施。结果显示，完善手术技术、缩短移植物冷热缺血时间及保护胆管血供是预防术后胆道并发症的关键。对于已发生胆道并发症者，应根据病情采取个体化治疗，适当处理后多可取得良好的疗效。

偏倚或不足：课题中仅有33例肝移植术后发生胆道并发症患者，病例数相对较少，在胆道并发症的处理上还需进一步总结经验。

摘要
目的: 胆道并发症是肝移植术后常见的并发症，严重影响肝移植患者的生存率和生活质量。课题拟进一步明晰认识肝移植术后胆道并发症的病因并确立早期防治措施。
方法：①对象：解放军总医院第二附属医院全军器官移植中心于2002-04/2007-09完成的254例原位肝移植患者中，术后发生胆道并发症者33例，回顾分析患者的临床资料。②方法：胆管重建方式为胆总管端端吻合术。并发胆漏者，予置管充分引流；吻合口狭窄者经皮肝穿刺胆道造影或经内镜逆行胰胆管造影球囊扩张术，必要时放置胆道支架；非吻合口狭窄者行经皮肝穿刺胆道造影联合胆道镜治疗，严重者行二次肝移植术。
结果：18例胆漏患者均通过腹腔引流、鼻胆管引流治愈；9例吻合口狭窄患者经内镜逆行胰胆管造影或经皮肝穿刺胆道造影球囊扩张术治愈，其中3例放置了胆道支架；6例非吻合口狭窄患者中，2例经皮肝穿刺胆道造影联合胆道镜治疗后痊愈，2例接受了二次肝移植，2例恢复不佳。
结论：改进手术方法、缩短移植物冷热缺血时间及保护胆管血供可降低肝移植术后胆道并发症的发生，治疗的关键在于早期诊断、合理选择治疗方法，处理得当患者可长期存活。
关键词：肝移植；手术后并发症；胆道疾病

金海龙，石炳毅，杜国盛，戴新，宋继勇，朱志东，王爽．肝移植术后胆道并发症33例分析[J].中国组织工程研究与临床康复，2008，12(5):831-834 [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-831(ps).pdf]

Analysis of biliary tract complications following liver transplantation in 33 cases

Abstract

AIM：Biliary complication is a common complication after liver transplantation, and severely affects the survival rate and quality of life of liver transplantation patients. The study was aimed to discuss etiological factors and treatment of biliary tract complications after liver transplantation.
METHODS: ①254 patients received orthotopic liver transplantation at the Organ Transplantation Center, Second Affiliated Hospital of General Hospital of Chinese PLA from April 2002 to September 2007. Clinical data of 33 patients with biliary tract complications after liver transplantation were studied retrospectively. ②The common bile ducts were all reconstructed by end-to-end anastomosis. The cases with biliary leak were administered thorough drainage. The cases with anastomotic biliary stricture were administered sacculus dilatation through percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). If necessary, some cases were placed biliary tract brackets. The patients with nonanastomotic biliary stricture were treated with PTC plus choledochoscope. The worse were treated with second liver transplantation.
RESULTS: Eighteen cases with biliary leak were cured through abdominal and nasobiliary drainage. Nine cases with anastomotic biliary stricture were administered sacculus dilatation through ERCP or PTC and were cured, including three cases were placed biliary tract brackets. Among six cases with nonanastomotic biliary stricture, two cases were cured through PTC associating with choledochoscope. Two cases were treated second liver transplantation. Two cases recovered worse.
CONCLUSION: The important steps to prevent biliary tract complications after liver transplantation are mature technique for operation, short lacking blood time to the implants and plenty blood supply to the biliaries. It is key that the patients survive for a long term through early diagnosis and reasonable treatment.

Jin HL, Shi BY, Du GS, Dai X, Song JY, Zhu ZD, Wang S.Analysis of biliary tract complications following liver transplantation in 33 cases..Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):831-834(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-831(ps).pdf]