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儿童劈离式肝移植的胆管分型与重建

韦金铭, 冯啸, 曾凯宁, 等. 儿童劈离式肝移植的胆管分型与重建[J]. 器官移植, 2022, 13(6): 791-796. doi: 10.3969/j.issn.1674-7445.2022.06.015
引用本文: 韦金铭, 冯啸, 曾凯宁, 等. 儿童劈离式肝移植的胆管分型与重建[J]. 器官移植, 2022, 13(6): 791-796. doi: 10.3969/j.issn.1674-7445.2022.06.015
Wei Jinming, Feng Xiao, Zeng Kaining, et al. Classification and reconstruction of bile duct in pediatric split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 791-796. doi: 10.3969/j.issn.1674-7445.2022.06.015
Citation: Wei Jinming, Feng Xiao, Zeng Kaining, et al. Classification and reconstruction of bile duct in pediatric split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 791-796. doi: 10.3969/j.issn.1674-7445.2022.06.015

儿童劈离式肝移植的胆管分型与重建

doi: 10.3969/j.issn.1674-7445.2022.06.015
基金项目: 

广东省自然科学基金 2020A1515010574

详细信息
    作者简介:
    通讯作者:

    易述红,博士,主任医师,研究方向为肝移植及其相关基础研究,Email:yishuhong@163.com

  • 中图分类号: R617, R575

Classification and reconstruction of bile duct in pediatric split liver transplantation

More Information
  • 摘要:   目的  探讨儿童劈离式肝移植左肝内胆管(LHD)的解剖分型、胆道重建方式及其与术后胆道并发症的关系。  方法  回顾性分析75例儿童劈离式肝移植受者的临床资料。供肝劈离前采用碘普罗胺注射液经胆总管逆行造影,根据二、三、四段肝内胆管走向确定供肝LHD的解剖分型,总结不同LHD分型的胆道重建方案,分析儿童劈离式肝移植术后胆道并发症的发生及治疗情况。  结果  75个供肝中,LHD解剖分型为Ⅰ型57例(76%)、Ⅱ型9例(12%)、Ⅲ型4例(5%)、Ⅳ型5例(7%)。75例儿童受者的胆道重建方案包括左肝管-空肠Roux-en-Y吻合69例(Ⅰ型53例、Ⅱ型8例、Ⅲ型4例、Ⅳ型4例),胆总管-空肠Roux-en-Y吻合1例(Ⅳ型),左肝管-胆总管端端吻合5例(Ⅰ型4例、Ⅱ型1例)。术后6例发生胆道并发症,发生率为8%,其中胆道吻合口狭窄3例,胆道吻合口胆漏2例,肝断面胆漏1例。发生在Ⅰ型4例,发生在Ⅲ型2例,LHD经典型与解剖变异型的胆道并发症发生率差异无统计学意义(均为P > 0.05)。3例胆道吻合口狭窄受者中,2例行经皮经肝胆道引流术(PTCD),1例行再次胆肠吻合术;2例胆道吻合口胆漏受者均行PTCD;1例断面胆漏受者予局部引流。6例患儿治疗后均存活。  结论  供肝中24%存在LHD的解剖变异,其中Ⅱ型最多,为12%。供肝劈离前常规胆道造影和精细的胆道吻合技术可以有效降低胆道并发症的发生率。术后胆道并发症的发生与LHD解剖分型无明显相关性。

     

  • 图  1  供肝LHD解剖分型

    注:A图示Ⅰ型;B图示Ⅱ型;C图示Ⅲ型;D图示Ⅳ型。红色数字2、3、4分别代表肝内二、三、四段胆管。

    Figure  1.  Anatomical classification of LHD of donor liver

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出版历程
  • 收稿日期:  2022-07-20
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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