中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (11): 1035-1037.

• 论著 • 上一篇    下一篇

肝移植围胆道重建环节技巧与细节对胆道并发症的影响研究

霍    枫，汪邵平，蒲淼水，陈建雄，李    鹏，郑于剑，詹世林   

  1. 广州军区广州总医院肝胆外科  肝脏移植中心，广东广州510010
  • 出版日期:2011-11-01 发布日期:2011-10-24

  • Online:2011-11-01 Published:2011-10-24

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摘要：

目的    探讨肝移植围胆道重建环节技巧与细节对胆道并发症的影响。方法    回顾性分析广州军区广州总医院2003年8月至2006年12月（A组，74例）和2007年1月至2010年3月（B组，131例）两个阶段共205例肝移植病人的临床资料，比较两组围胆道重建环节技巧与细节的差异，统计术后胆道并发症及预后情况。 结果    两组胆管重建方式和围手术期病死率差异均无统计学意义。B组除温缺血时间显著短于A组外，在供肝胆管灌洗、供肝动脉和供受体胆管血供保护、受体胆道下段探查、供受体胆管吻合张力等方面与A组不同。B组胆道并发症发生率为5.3%，显著低于A组（11.0%）。 结论    肝移植围胆道重建环节注意缩短温缺血时间并注重供肝胆管灌洗、供肝动脉和供受体胆管血供保护、受体胆管下端探查、胆管吻合微张力等技巧和细节，可显著降低胆道并发症发生率。

关键词: 肝移植, 胆道重建, 胆道并发症

Abstract:

Effect of the surgical techniques and details around biliary reconstruction process on the biliary complications in orthotopic liver transplantation        HUO Feng, WANG Shao-ping, PU Miao-shui, et al. Department of Hepatobiliary Surgery, Guangzhou General Hospital, Guangzhou Military Area of PLA, Guangzhou 510010 China
Corresponding  author ：HUO Feng, E-mail：gzhuofeng@163.com
Abstract    Objective    To investigate the effect of the surgical techniques and details around biliary reconstruction process on the biliary complications in liver transplantation. Methods    From August 2003 to December 2006 and January 2007 to March 2010 two time periods, group A 74 cases and group B 131 cases each, all 205 cases of liver transplantation fulfilled in Guangzhou General Hospital of PLA were implemented biliary reconstruction with same methods. Some different surgical techniques and details and the rates of the biliary duct complication were compared statistically. Results    The death rates of group A and group B had no difference statistically. But the biliary complication incidence of group A and group B had was 11.0% and 5.3% respectively. The warm ischemia time of group B was shorter than that of group A significantly. There were some differences between two groups, such as the perfusion of the biliary duct, the conservation of blood supply of biliary endings for both donor and recipient, careful bile duct exploration in receptor, and minor tension between the anastomosis of the bile duct. Conclusion    With short warm ischemia time, adequate perfusion of bile duct of the liver donor, conservation of blood supply of biliary endings for both donor and recipient, careful bile duct exploration in receptor and minor tension between the anastomosis of the bile duct are all important factors for improving the quality of biliary reconstruction and reducing biliary complications.

Key words: liver transplantation, biliary reconstruction, biliary complication