文章摘要
张 杰,张传永,钱晓峰,丁文斌,戴佳敏,张 峰.心脏死亡供体原位肝移植术后胆道并发症的原因探讨和诊疗经验[J].南京医科大学学报,2017,(7):857~860
心脏死亡供体原位肝移植术后胆道并发症的原因探讨和诊疗经验
Etiology, diagnosis,and treatment of biliary complications after orthotopic liver transplantation from donation after cardiac death
投稿时间:2017-02-03  
DOI:10.7655/NYDXBNS20170714
中文关键词: 肝移植;心脏死亡供体  胆道并发症;治疗
英文关键词: liver transplantation  donation after cardiac death  biliary complications  treatment
基金项目:国家自然科学基金(81273262)
作者单位
张 杰 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
张传永 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
钱晓峰 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
丁文斌 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
戴佳敏 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
张 峰 南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室江苏 南京 210029 
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中文摘要:
      目的: 探讨心脏死亡供体(donation after cardiac death,DCD)原位肝移植术后胆道并发症的发生因素、诊断要点和治疗方法。方法: 对2015年1月—2016年8月于南京医科大学第一附属医院肝移植中心实施的87例DCD供肝肝移植患者临床资料进行回顾性分析。87例中29例行经典原位肝移植,58例行改良背驮式肝移植,胆管重建方式均为胆总管端端吻合,无1例放置T管。结果: 87例肝移植患者中9例通过胆道造影确诊为肝移植术后胆道并发症, 8例治愈, 1例好转, 无死亡。胆道并发症发生率10.1%(9/87)。结论: DCD供体原位肝移植术后胆道并发症的发生与供肝缺血时间、DCD供肝质量、胆管吻合技术及供肝修剪技术等因素有关,术后胆道造影有助于及时诊断胆道并发症。介入技术是胆道并发症的主要治疗手段。
英文摘要:
      Objective: To study the etiology, diagnosis and treatment of biliary complications after orthotopic liver transplantation (OLT) from donation after cardiac death (DCD). Methods:Eighty-seven recipients who had received liver transplantation from DCD in the First Affiliated Hospital of Nanjing Medical University between January 2015 and August 2016 were retrospectively reviewed. Fifty-eight cases received modified piggyback liver transplantation. The bile duct was reconstructed by end-to-end anastomosis of the common bile duct. No cases used the T tube. Results: Biliary complications was diagnosed cholangiographyically in 9 cases. Eight patients were cured,one patient was improved,and no patient died. The incidence for biliary complications was 10.1%(9/87). Conclusion: Long ischemic time of the graft, poor quality of donor’s liver graft, poor techniques for anastomosis and repair of the graft and other factors may contribute to the biliary complications after liver transplantation from DCD. Early cholangiography is helpful to diagnose biliary complications. Endoscopic and/or radiological interventions should be the main treatment for biliary complications.
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