CAJ | 학술논문

背景：既往文献主要探讨胆道并发症的原因及治疗，而较少文献报道如何改进具体手术技巧预防胆道并发症的发生。 　　目的：探讨肝脏移植过程中胆道相关手术技巧对胆道并发症发生率的影响。 　　方法：回顾性分析解放军第309医院收治的475例患者肝移植后发生胆道并发症的情况，应用Logistic回归分析观察胆道并发症的发生与相关手术技术变化之间的关系，归纳可能的相关危险因素，提出预防胆道并发症的具体措施。 　　结果与结论：475例肝移植患者肝移植后共发生胆道并发症36例(7.6%)，包括胆管非吻合口狭窄(n=19，4.0%)、胆管吻合口狭窄(n=7，1.5%)、移植后胆瘘(n=3，0.6%)、胆总管迂曲(n=3，0.6%)、胆总管结石残留(n=1，0.2%)、远期胆总管结石(n=3，0.6%)。统计结果显示胆道吻合方式对非吻合口狭窄发生率无明显影响，临床显示留置“T”形管组造成胆管狭窄的可能性小于其他两组，但统计学显示组间比较无明显差异，肠系膜上静脉插管取肝和取肝时即进行胆道灌注可降低胆道并发症的发生率(P=0.013和 P=0.018，OR=0.26和OR=0.28)，取肝时即对胆道进行灌注可明显降低非吻合口胆管狭窄的发生率(P=0.001，OR=0.09)。同时，修肝时尽量减少供、受者胆道血供的丢失、于肝脏膈面垫高肝脏进行胆道吻合等手术技巧均可降低胆道并发症发生率。
배경：기왕문헌주요탐토담도병발증적원인급치료，이교소문헌보도여하개진구체수술기교예방담도병발증적발생。 　　목적：탐토간장이식과정중담도상관수술기교대담도병발증발생솔적영향。 　　방법：회고성분석해방군제309의원수치적475례환자간이식후발생담도병발증적정황，응용Logistic회귀분석관찰담도병발증적발생여상관수술기술변화지간적관계，귀납가능적상관위험인소，제출예방담도병발증적구체조시。 　　결과여결론：475례간이식환자간이식후공발생담도병발증36례(7.6%)，포괄담관비문합구협착(n=19，4.0%)、담관문합구협착(n=7，1.5%)、이식후담루(n=3，0.6%)、담총관우곡(n=3，0.6%)、담총관결석잔류(n=1，0.2%)、원기담총관결석(n=3，0.6%)。통계결과현시담도문합방식대비문합구협착발생솔무명현영향，림상현시류치“T”형관조조성담관협착적가능성소우기타량조，단통계학현시조간비교무명현차이，장계막상정맥삽관취간화취간시즉진행담도관주가강저담도병발증적발생솔(P=0.013화 P=0.018，OR=0.26화OR=0.28)，취간시즉대담도진행관주가명현강저비문합구담관협착적발생솔(P=0.001，OR=0.09)。동시，수간시진량감소공、수자담도혈공적주실、우간장격면점고간장진행담도문합등수술기교균가강저담도병발증발생솔。
BACKGROUND:Previous studies have reported the cause and treatment of biliary complication. However, how to improve operative technique for preventing the complication is rarely reported. OBJECTIVE:To explore the effect of operational skil s during liver transplantation on biliary complications. METHODS:Biliary complications in 475 patients who underwent liver transplantation were retrospectively analyzed. The relationship between operational skil s and biliary complications after liver transplantation was observed. The potential risk factors about operative technique were summarized. Some preventive interventions for biliary complications were suggested. RESULTS AND CONCLUSION:Biliary complication was diagnosed in 36 (7.6%) of 475 patients who underwent liver transplantation. They were nonanastomotic biliary stricture (n=19, 4.0%), anastomotic biliary stricture (n=7, 1.5%), biliary leakage (n=3, 0.6%), twisted common biliary duct (n=3, 0.6%), residual common duct stone (n=1, 0.2%), and neoformative common duct stone (n=3, 0.6%). There was no difference in the incidence of nonanastomotic biliary stricture among the three biliary anastomotic styles. The possibility of anastomotic biliary stricture in placing T-drainage tube group was lower than the other two groups according to clinical data. Nevertheless, there was no statistical difference between these three groups. Infusing UW into the liver from cranial mesenteric vein and douching the biliary duct immediately while taking the donor could decrease the incidence of biliary complication after liver transplantation (P=0.013 and P=0.018, OR=0.26 and OR=0.28), the later factor could also decrease the incidence of nonanastomotic biliary stricture (P=0.001, OR=0.09). Meanwhile, some operational skil s also decrease the incidence of biliary complications, such as protecting the artery around the biliary duct, and elevating the liver when suturing the common biliary duct.