肝移植术后肝内外多发缺血型胆道病变的治疗分析

摘要

Objective To evaluate the treatment and prognosis of multiple intra-and extrahepat-ic ischemic-type biliary lesions (ITBLs) following liver transplantation. Method A retrospective anal-ysis was made for 31 cases with ITBLs after liver transplantation from December 2004 to May 2006. Results Of the 31 cases with a mean age of(48.6+9.6) years, 28 were male and 3 female. The mean interval from operation to diagnosis of ITBLs was (271.29±149.32) d. Oonly 8 cases combined with severe hepatic artery stenosis and 1 case with bile leakage. The treatment options were divided in-to five categories: (1) Interventional treatments (using ERC or PTC) in 8 cases. (2) Interventional measures were the first-line treatment and then re-transplantation in 7 cases. (3) retransplantation without interventional measures in 5 cases. (4) conservative treatment in 8 cases. (5) hepaticjejunos-tomy in 1 case. Six of the 31 cases were cured, the condition of 7 patients was improved, and 10 pa-tients died. The mortality was 32.3% (10/31). Interventional measures were associated with high mortality (53.3%,8/15)whether these cases received retrasnplantation or not. Six cases were im-proved when they only received conservative treatment and 1 suffering from refractory biliary infec-tions treated with hepaticojejunostomy. Conclusion Interventional treatment could not help to cure the cases with multiple intra-and extrahepatic ITBLs or improve their condition. Proper conservative treatment can effectively avoid or at least delays retransplantation. Timely re-transplantation is essen-tial to cure this complication.%目的 探讨原位肝移植术后肝内外多发缺血型胆道病变的治疗及预后.方法 回顾性分析2003年12月至2006年5月收治的31例肝移植术后并发肝内外多发缺血型胆道病变病例的临床资料,总结此类病例的治疗选择策略及相应预后.结果 31例病例中,男28例,女3例;年龄32～66岁,平均年龄(48.6+9.6)岁.平均发生时间在肝移植(271.29±149.32)d,合并严重肝动脉狭窄8例,合并胆漏1例,采用介入治疗8例、介入治疗+再移植术7例、再移植术5例.内科治疗8例,胆肠吻合术1例、2例病人放弃治疗.6例痊愈,均为再移植病人,好转7例,无效6例,死亡10例,死因为多器官功能衰竭(6例),胆道感染(3例),非胆道病变(1例).总治愈率和死亡率分别为19.4%(6/31)和32.3%(10/31).反复介入治疗后无论施行肝移植与否,均具有较高的死亡率(53.3%,8/15).8例内科保守治疗病人有6例病情好转并相对稳定,1例胆肠吻合病人出现反复胆道感染.结论 对肝移植术后肝内外多发缺血型胆道病变,介入方法 的诊断价值高于治疗价值,合理的内科治疗有助于病情的稳定及推迟再移植的时间,而正确把握再移植的时机是治愈本病的关键.