成人原位肝移植术后常见胆道并发症的诊疗

胡鑫文; 李亭

doi:10.3969/j.issn.1674-7445.2022.05.004

成人原位肝移植术后常见胆道并发症的诊疗

doi: 10.3969/j.issn.1674-7445.2022.05.004

胡鑫文,
李亭^,

430011 长沙，中南大学湘雅二医院肝脏移植科，移植医学研究中心

基金项目:

湖南省自然科学基金 2022JJ30816

长沙市自然科学基金 kq2014237

详细信息

作者简介:

通讯作者:
李亭，Email：liting001@csu.edu.cn

中图分类号: R617,R657.4
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- PDF下载量: 106
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-01
- 网络出版日期: 2022-09-14
- 刊出日期: 2022-09-15

Diagnosis and treatment of common biliary complications after orthotopic liver transplantation in adults

Hu Xinwen,
Li Ting^,

Department of Liver Transplantation, Transplant Medicine Research Center, the Second Xiangya Hospital of Central South University, Changsha 430011, China

More Information

Corresponding author: Li Ting, Email: liting001@csu.edu.cn

摘要

摘要: 肝移植已成为治疗终末期肝病的有效方法，由于外科技术、供者选择、器官保存和运输、免疫抑制药、围手术期管理的长足发展，肝移植总体手术并发症明显下降，但胆道并发症发生率仍处于较高水平。当前，肝移植术后胆道并发症仍是导致移植物失功的重要原因，关于胆道并发症的发病机制及诊治仍存在争议，也是近年来器官移植领域的研究热点。本文尝试对成人原位肝移植术后胆道并发症的新突破和进展进行总结，为进一步解决胆道并发症相关临床问题提供理论基础。
- 原位肝移植 /
- 胆道并发症 /
- 胆道狭窄 /
- 胆漏 /
- 内镜逆行胰胆管成像（ERCP） /
- 经皮穿刺肝胆道成像（PTC） /
- 磁共振逆行胰胆管造影（MRCP） /
- 全覆膜自膨式金属支架
Abstract: Liver transplantation has become an effective treatment for end-stage liver diseases. With rapid development of surgical techniques, donor selection, organ preservation and transportation, immunosuppressants and perioperative management, the overall incidence of complications after liver transplantation has been significantly decreased, whereas the incidence of biliary complications remains relatively high. At present, biliary complications after liver transplantation are still an important cause of graft failure. Nevertheless, the pathogenesis, diagnosis and treatment of biliary complications remain controversial, which are also research hotspots in the field of organ transplantation in recent years. In this article, new breakthrough and research progress upon biliary complications after orthotopic liver transplantation in adults were reviewed, aiming to provide theoretical basis for resolving biliary complications-related clinical issues.

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图 1 非吻合口狭窄解剖位置分区

注：肝门分叉（A区）、一级和二级分支之间的胆管（B区）、二级和三级分支之间的胆管（C区）和肝脏周围的胆管（D区）^[26]。

Figure 1. Anatomic location division of non-anastomotic stenosis

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图 2 原位肝移植术后胆道并发症的诊治思路

注：MRA为磁共振血管造影，CTA为CT血管造影，PTCD为经皮经肝胆道引流术。

Figure 2. Diagnosis and treatment idea of biliary complications after orthotopic liver transplantation

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表 1 原位肝移植术后常见胆道并发症

Table 1. Common biliary complications after orthotopic liver transplantation

胆道并发症	发生时间及原因	发生部位	发生率
胆漏	早期（≤4周）：局部缺血或外科手术技术因素；晚期（> 4周）：T管拔除	吻合口、T管出口、胆囊管、Lushka胆管、副胆管、肝断面	2%~25%
吻合口狭窄	早期（≤3个月）：外科手术技术因素；晚期（> 3个月）：局部缺血、胆漏、感染等	距离吻合口5 mm以内	5%~10%
非吻合口狭窄	早期（≤1年）：缺血性；晚期（> 1年）：免疫性	吻合口5 mm以外的肝内外胆管	0.5%~9.6%

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