Prevention experience of biliary tract complications after liver transplantation from organ donation after citizen's death
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摘要:
目的 总结公民逝世后器官捐献供肝移植的胆道并发症预防经验。 方法 回顾性分析2008年10月至2016年12月中山大学附属中山医院88例公民逝世后器官捐献肝移植病例的临床资料。 结果 88例均符合中国标准三类捐献(即脑-心双死亡标准器官捐献)。所有病例按标准获取流程成功完成肝脏捐献, 88例受者均顺利植入供肝, 胆道重建多采用胆管端端吻合, 供者胆管尽可能短, 吻合时保持微张力。未出现原发性移植肝无功能、排斥反应。1例患者出现胆漏经引流3周后自愈, 2例患者出现胆道狭窄并发症, 经置入胆道支架后缓解。 结论 加强获取器官管理, 采用规范的获取供肝流程, 充分利用体外膜肺氧合(ECMO), 尽量缩短热、冷缺血时间, 注意胆道重建技巧, 有助于减少胆道并发症发生率, 公民逝世后器官捐献供肝移植可以取得满意的临床效果。 Abstract:Objective To summarize the experience of prevention of biliary tract complications after liver transplantation from organ donation after citizen's death. Methods Clinical data of 88 cases undergoing liver transplantation from organ donation after citizen's death in the Affiliated Zhongshan Hospital of Sun Yat-sen University from October 2008 to December 2016 were retrospectively analyzed. Results Eighty-eight cases were eligible for the standards for organ donation after brain death plus cardiac death according to the Ⅲ national system for organ donation in China. According to the standard procedures, donor livers were successfully harvested and transplanted in 88 recipients. The biliary tract was reconstructed using the bile duct end-to-end anastomosis. The length of bile duct in the donors was shortened as possible. Slight tension should be maintained during anastomosis. Neither primary liver graft nonfunction nor rejection reaction occurred. One recipient suffered from bile leakage and recovered after drainage for 3 weeks. Two patients presented with biliary tract stenosis and mitigated after the placement of biliary tract stent. Conclusions The harvesting of donor liver should be in accordance with the standard procedures. The advantages of extracorporeal membrane oxygenation (ECMO) should be fully utilized to shorten warm and cold ischemia time as possible. Much attention should be diverted to the reconstruction of biliary tract, which contributes to decreasing the risk of biliary tract complications. Favorable clinical efficacy can be achieved in liver transplantation from organ donation after citizen's death. -
[1] 俞军, 谢尚奋, 夏伟良, 等.心脏死亡供者肝移植受者胆道并发症风险因素分析[J].浙江大学学报(医学版), 2014, 43(6): 664-669. DOI: 10.3785/j.issn.1008-9292.2014.11.005.Yu J, Xie SF, Xia WL, et al. Risk factors of biliary complications after liver transplantation from donation after cardiac death[J]. J Zhejiang Univ (Med Sci), 2014, 43(6): 664-669. DOI: 10.3785/j.issn.1008-9292.2014.11.005. [2] Nguyen JH, Bonatti H, Dickson RC, et al. Long-term outcomes of donation after cardiac death liver allografts from a single center[J]. Clin Transplant, 2009, 23(2): 168-173. DOI: 10.1111/j.1399-0012.2009.00968.x. [3] 中华医学会器官移植学分会.中国心脏死亡器官捐献工作指南[J].中华器官移植杂志, 2010, 31(7): 436-437. DOI: 10.3760/cma.j.issn.0254-1785.2010. 07.015.Branch of Organ Transplantation of Chinese Medical Association. Guidelines on Chinese cardiac death organ donation[J]. Chin J Organ Transplant, 2010, 31(7): 436-437. DOI: 10.3760/cma.j.issn.0254-1785.2010.07.015. [4] Lewis J, Peltier J, Nelson H, et al. Development of the University of Wisconsin donation after cardiac death evaluation tool[J]. Prog Transplant, 2003, 13(4): 265-273. doi: 10.1177/152692480301300405 [5] Seehofer D, Eurich D, Veltzke-Schlieker W, et al. Biliary complications after liver transplantation: old problems and new challenges[J]. Am J Transplant, 2013, 13(2): 253-265. DOI: 10.1111/ajt.12034. [6] 黄东东, 胡泽民, 何坤, 等.公民逝世后器官捐献供肝移植62例临床分析[J/CD].中华普通外科学文献(电子版), 2016, 10(5): 359-362. DOI: 10.3877/cma.j.issn.1674-0793.2016.05.009.Huang DD, Hu ZM, He K, et al. Clinical analysis of 62 cases of liver transplantation from donation after citizen death[J/CD]. Chin Arch Gen Surg (Electr Vers), 2016, 10(5):359-362. DOI: 10.3877/cma.j.issn.1674-0793.2016.05.009. [7] 霍枫, 汪邵平, 李鹏, 等.体外膜肺氧合用于心死亡供肝的初步经验[J].中华肝胆外科杂志, 2012, 18(5): 354-356. DOI: 10.3760/cma.j.issn.1007-8118.2012.05.011.Huo F, Wang SP, Li P, et al. Extracorporeal membrane oxygenation support for liver donation after cardiac death[J]. Chin J Hepatobiliary Surg, 2012, 18(5): 354-356. DOI: 10.3760/cma.j.issn.1007-8118.2012.05.011. [8] Foley DP, Fernandez LA, Leverson G, et al. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center[J]. Ann Surg, 2011, 253(4): 817-825. DOI: 10.1097/SLA.0b013e3182104784. [9] 唐彬, 王宇, 周杰, 等.肝移植术后胆道并发症的危险因素分析[J].中国普通外科杂志, 2011, 20(1): 1-5. http://cdmd.cnki.com.cn/Article/CDMD-10598-1012490064.htmTang B, Wang Y, Zhou J, et al. Analysis of the risk factors for biliary complications after liver transplantation[J]. Chin J Gen Surg, 2011, 20(1):1-5. http://cdmd.cnki.com.cn/Article/CDMD-10598-1012490064.htm [10] 郑树森, 陈海勇.肝移植术后难治性胆道并发症的防治进展[J].中华消化外科杂志, 2007, 6(2): 81-82.DOI: 10.3760/cma.j.issn.1673-9752.2007.02.001.Zheng SS, Chen HY. Research progress in prevention and treatment of refractory biliary complications after liver transplantation[J]. Chin J Dig Surg, 2007, 6(2): 81-82. DOI: 10.3760/cma.j.issn.1673-9752.2007.02.001. [11] 宋继勇, 杜国盛, 朱志东, 等.肝移植过程中胆道相关手术技巧与胆道并发症的关系[J].中国组织工程研究, 2014, 18(27): 4299-4303. DOI: 10.3969/j.issn.2095-4344.2014.27.007.Song JY, Du GS, Zhu ZD, et al. Operative techniques in liver transplantation and biliary complications[J]. Chin J Tissue Eng Res, 2014, 18(27): 4299-4303. DOI: 10.3969/j.issn.2095-4344.2014.27.007. [12] Jorgensen JE, Waljee AK, Volk ML, et al. Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? a Meta-analysis[J]. Gastrointest Endosc, 2011, 73(5): 955-962. DOI: 10.1016/j.gie.2010.12.014. [13] Poley JW, Lekkerkerker MN, Metselaar HJ, et al. Clinical outcome of progressive stenting in patients with anastomotic strictures after orthotopic liver transplantation[J]. Endoscopy, 2013, 45(7): 567-570. DOI: 10.1055/s-0032-1326411. [14] Arain MA, Attam R, Freeman ML. Advances in endoscopic management of biliary tract complications after liver transplantation[J]. Liver Transpl, 2013, 19(5): 482-498. DOI: 10.1002/lt.23624. [15] Chan CH, Donnellan F, Byrne MF, et al. Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 488-493. doi: 10.1016/S1499-3872(13)60077-6 [16] Cai XB, Zhu F, Wen JJ, et al. Endoscopic treatment for biliary stricture after orthotopic liver transplantation: success, recurrence and their influencing factors[J]. J Dig Dis, 2012, 13(12): 642-648. DOI: 10.1111/j.1751-2980.2012.00640.x. [17] 邓斐文, 陈焕伟, 甄作均, 等.内镜逆行胆胰管造影术处理心脏死亡器官捐献供体肝移植受体术后胆道狭窄临床分析[J/CD].中华普通外科学文献(电子版), 2015, 9(2): 124-128. DOI: 10.3877/cma.j.issn.1674-0793.2015.02.010.Deng FW, Chen HW, Zhen ZJ, et al. Endoscopic retrograde cholangiopancreatography in the treatment of biliary strictures after liver transplantation with donation after cardiac death[J/CD]. Chin Arch Gen Surg (Electr Vers), 2015, 9(2): 124-128. DOI: 10.3877/cma.j.issn.1674-0793.2015.02.010. [18] 唐晖, 陈规划.肝移植术后缺血性胆道损伤研究进展[J].器官移植, 2014, 5(2): 123-127. DOI: 10.3969/j.issn.1674-7445.2014.02.014.Tang H, Chen GH. Research progress of ischemic-type biliary lesion after liver transplantation[J]. Organ Transplant, 2014, 5(2): 123-127. DOI: 10.3969/j.issn.1674-7445.2014.02.014. [19] 杨扬, 王金锐, 郑荣琴, 等.中国大陆地区肝移植后缺血性胆道病变诊断及治疗专家共识[J].器官移植, 2015, 6(1): 1-5. DOI: 10.3969/j.issn.1674-7445.2015.01.03.Yang Y, Wang JR, Zheng RQ, et al. Expert consensus document on diagnosis and therapy of ischemic-type biliary lesions after liver transplantation in Chinese Mainland[J]. Organ Transplant, 2015, 6(1): 1-5. DOI: 10.3969/j.issn.1674-7445.2015.01.03.
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