活体右半供肝移植后胆道并发症的中长期随访研究及危险因素分析
활체우반공간이식후담도병발증적중장기수방연구급위험인소분석
Risk factors and long-term follow-up results for biliary complications after right lobe living donor liver transplantation
  • 万方数据
    中华器官移植杂志 중화기관이식잡지
    CHINESE JOURNAL OF ORGAN TRANSPLANTATION
    2012年 4期 208-211 ,共4页

    张子宏%夏强%张建军%李齐根%徐宁%陈小松%薛峰%韩龙志%夏雷%邢天宇%王鑫%罗毅%沈从欢%奚志峰

    장자굉%하강%장건군%리제근%서저%진소송%설봉%한룡지%하뢰%형천우%왕흠%라의%침종환%해지봉

    肝移植%活体供者%手术后并发症%胆道%危险因素 肝移植%活體供者%手術後併髮癥%膽道%危險因素
    간이식%활체공자%수술후병발증%담도%위험인소
    Liver transplantation%Living donors%Postoperative complications%Biliary tract%Risk factors
    目的 研究活体右半供肝移植术后胆道并发症的发生特点和发生胆道狭窄的独立危险因素.方法 回顾性分析2007年4月至2010年4月105例成人活体右半供肝移植受者的临床资料,分析术后胆道并发症的发生率、发生时间及发生胆道狭窄的独立危险因素.结果 105例受者中位随访时间为49.5个月(562～1675 d),术后发生胆道并发症40例(占38.1％),其中胆漏11例(10.4％)和胆道狭窄37例(35.2％).发生胆漏的中位时间为7 d(4～54 d),发生胆道狭窄的中位时间为7.6个月(12～790d),75.7％的胆道狭窄发生在术后1年内.术后1年内胆道狭窄的发生率明显高于术后1年后.胆道狭窄发生的独立危险因素为术后发生胆漏、胆道吻合口径≤3 mm和CMV感染.结论 活体右半供肝移植术后胆道狭窄发生的独立危险因素为胆漏、胆道口径≤3 mm和CMV感染.为减少胆道并发症,术前应充分了解供、受者的胆道情况,术中提高肝移植手术技术、尽量避免损伤胆道供血血管,术后1年内应严密随访、注意预防CMV感染.
    목적 연구활체우반공간이식술후담도병발증적발생특점화발생담도협착적독립위험인소.방법 회고성분석2007년4월지2010년4월105례성인활체우반공간이식수자적림상자료,분석술후담도병발증적발생솔、발생시간급발생담도협착적독립위험인소.결과 105례수자중위수방시간위49.5개월(562～1675 d),술후발생담도병발증40례(점38.1％),기중담루11례(10.4％)화담도협착37례(35.2％).발생담루적중위시간위7 d(4～54 d),발생담도협착적중위시간위7.6개월(12～790d),75.7％적담도협착발생재술후1년내.술후1년내담도협착적발생솔명현고우술후1년후.담도협착발생적독립위험인소위술후발생담루、담도문합구경≤3 mm화CMV감염.결론 활체우반공간이식술후담도협착발생적독립위험인소위담루、담도구경≤3 mm화CMV감염.위감소담도병발증,술전응충분료해공、수자적담도정황,술중제고간이식수술기술、진량피면손상담도공혈혈관,술후1년내응엄밀수방、주의예방CMV감염.
    Objective To characterize the clinical course of biliary complications after right lobe living donor liver transplantation (RL-LDLT) and to identify the independent risk factors for biliary strictures.Methods 105 consecutive RL-LDLT recipients operated from April 2007 to April 2010 were followed up. The clinical and operative data were reviewed. The biliary complications and independent risk factors of biliary stricture were studied.Results The median follow-up duration was 49.5 months ranging from 562 to 1675 days.A total of 40 patients (38.1 ％) experienced 11 bile leak episodes (10.4％ ) and 37 (35.2％) biliary stricture episodes after transplantation.Bile leaks occurred at a median time of 9 days ranging from 4 to 54 days after transplantation.For biliary strictures,the occurring time was delayed and scattered wide with a median of 7.6 months ranging from 12 to 790 days after transplantation. Moreover, the biliary stricture incidence in the first year after transplantation was significantly higher than later.The independent risk factors for biliary strictures were CMV infection,bile leaks and bile duct size (≤3 mm).Conclusion The independent risk factors for biliary strictures after RL-LDLT were CMV infection,bile leaks and bile duct size (≤3mm).In order to avoid biliary complications,careful preoperative evaluations are necessary. The dissection of bile ducts should be meticulous to protect its blood supply.CMV infection should be prevented after transplantation.Close surveillance of biliary complications should be given to RL-LDLT recipients during the first year after transplantation.
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