目的

探讨肝移植胆道重建时选择胆肠吻合术的手术指征和相关并发症的防治。

方法

回顾性分析2004 年10 月至2006 年10 月完成的胆道重建选用胆肠吻合术式的肝移植患者的临床资料，总结肝移植术施行胆道吻合指征和相关并发症防治经验。

结果

共有24 例患者胆道重建选择了胆肠吻合术式，占同期施行肝移植总例数的5.72%（24/421）。选择指征包括再移植、胆道局部解剖条件及原发疾病限制等多种因素。总的并发症发生率为25%，分别为胆道吻合口狭窄（3例）、胆道逆行感染（2 例）和胆道吻合口狭窄并胆漏（1 例）。危险因素分析发现术前肝功能分级为Child-pugh C 级患者更容易出现胆道并发症（P<0.05）。采用经PTC 的介入治疗和加强抗感染处理，4 例痊愈，1 例出现感染性休克死亡，1 例发生缺血坏死性胆道病变。

结论

胆道狭窄和胆道逆行感染仍是主要的胆道并发症，正确把握胆道重建选择胆肠吻合术的适应证，规范手术方式和有选择地放置胆道引流管可以降低此类并发症的发生。

Objective

To evaluate the application and rate of complications related to Roux-en-Y choledochojejunostomy in liver transplantation.

Methods

A retrospective analysis was made for 24 cases who received choledochojejunostomy in liver transplantation consecutively in our transplantation center.

Results

421 transplantation procedures were performed from Oct.2004 to Oct.2006， 24 patients chose choledochojejunostomy.18 patients were cured.Biliary complications occurred in 6 patients (25%)， including anastomotic strictures (3 patients)， ascending cholangitis (2 patients) ， anastomotic strictures combined with bile leakage (1 patient). A univariate statistical analysis found that the risk factors for biliary complication were Child-Pugh stage C (P<0.05).4 patients were successfully treated by percutaneous transhepatic balloon dilatation and stenting. 1 patient suffered from extensive biliary necrosis and 1 patient was died of septic shock.

Conclusion

Hepaticojejunostomy is a safe and highly effective biliary reconstruction during orthotopic liver transplantation， especially when the recipients' bile duct is absent or otherwise destroyed，but anastomotic strictures and ascending cholangitis are still common complications. Compromised primary surgery and selective use of external biliary drainage may help to reduce biliary complication associated with hepaticojejunostomy.