中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (01): 81-83.

• 论著 • 上一篇    下一篇

肝移植治疗复杂性胆道损伤

严佶祺，彭承宏，杨卫平，沈柏用，周光文，陈拥军，陈皓，申川，李宏为   

  1. 上海交通大学医学院附属瑞金医院外科，上海 200025
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-02 发布日期:2009-03-02

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-02 Published:2009-03-02

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摘要：

【摘要】 目的 探讨肝移植在胆道损伤修复失败病例中的应用价值。方法 回顾分析2006年11月至2007年5月上海交通大学医学院附属瑞金医院收治的2例胆道损伤修复后失败而行肝移植治疗的病例资料。结果 1例病人因腹腔镜胆囊切除造成胆道损伤(Stragsberg E4型)合并肝固有动脉损伤，经胆肠Reux-en-Y吻合修复失败后而行尸体肝移植；另1例病人是由于幼时外伤而造成胆道损伤(Stragsberg E2型)，虽历经多次修复手术，但最终发展为继发性胆汁性肝硬化而行活体肝移植。经初步随访2例病人的肝移植效果满意。结论 当胆道损伤合并严重血管损伤，或修复失败发展至继发性胆汁肝硬化时需要考虑行肝移植治疗。

关键词: 肝移植, 胆道损伤, 血管损伤, 胆汁性肝硬化

Abstract:

Liver transplantation in treatment of complicated biliary injury YAN Ji-qi, PENG Cheng- hong, YANG Wei-ping, et al. Department of Surgery, Ruijin Hospital, Medical School of Shanghai Jiaotong University， Shanghai 200025, China. Corresponding author： PENG Cheng-hong, E-mail:chhpeng@188.com Abstract Objective To investigate liver transplantation in treatment of failed cases after surgical interventions for bile duct injury. Methods From November 2006 to May 2007, two cases of failed cases after surgical interventions for bile duct injury were admitted into our hospital. These clinical data were analyzed retrospectively. Results Bile duct injury (Strasberg E4) in one patient was caused by laparoscopic cholecystectomy concomitant with proper hepatic artery lesion, after the failure of previous Roux-en-Y hepaticojejunostomy, the patient received corpse liver transplantation. Bile duct injury (Strasberg E2) in another patient was caused by abdominal trauma in childhood, after several unsuccessful surgical interventions, the patient developed secondary biliary cirrhosis, and therefore, received living related liver transplantation. The outcome of both patients was satisfactory. Conclusion Liver transplantation should be considered when bile duct injury happens concomitant with severe vascular injury or secondary biliary cirrhosis occurs after failure of surgical intervention.

Key words: liver transplantation, bile duct injury, vascular injury, biliary cirrhosis