公民逝世后器官捐献供肝移植胆道并发症的预防经验
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.
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