摘要目的 探讨肝移植术后胆道并发症的相关因素及综合诊治经验.方法 回顾性分析2000年10月至2012年3月366例连续术后肝移植患者的临床资料.男性292例,女性72例,年龄18 ～69岁,平均年龄44.5岁.记录患者术后胆道并发症情况.采用单因素分析及Logistic多因素回归分析术后胆道并发症的危险因素.并发胆漏患者予置管充分引流.吻合口狭窄者经皮经肝胆道造影或经内镜逆行胰胆管造影行球囊成形术,必要时放置胆道支架；非吻合口狭窄者行经皮经肝胆道造影联合胆道镜治疗.结果 术后随访10 ～ 129个月,平均58.5个月,366例原位肝移植患者术后发生胆道并发症42例(11.5％).单因素分析及Logistic多因素回归分析结果示,第2次热缺血时间(门静脉血流复通到肝动脉血流复通的时间)、术中出血量和胆道吻合口直径与肝移植术后胆道并发症的发生相关(Wald=9.474～ 17.208,P＜0.05).12例胆漏患者通过腹腔引流、鼻胆管引流治愈；22例吻合口狭窄患者经内镜逆行胰胆管造影或经皮经肝胆道造影球囊成形术治愈,其中6例放置了胆道支架；8例非吻合口狭窄患者中,6例经皮经肝胆道造影联合胆道镜治疗后痊愈,1例接受二次肝移植后痊愈,1例恢复不良.结论 第2次热缺血时间、术中出血量和吻合口大小是肝移植术后胆道并发症的危险因素.肝移植术后胆管非弥漫性狭窄及胆漏的微创治疗安全、有效.

abstractsObjective To discuss the relevant factors of biliary complications after liver transplantation and to investigate the value of comprehensive management for the complications.Methods The data of 366 patients undergoing liver transplantation from October 2000 to March 2012 was analyzed retrospectively,and the risk factors were analyzed by univariate analysis and Stepwise Logistic regression.The cases with biliary leak were administered thorough drainage.The cases with anastomotic biliary stricture were administered sacculus dilatation through percutaneous transhepatic cholangiography (PTC) and endoscopicretrograde cholangiopancreatography (ERCP).If necessary,some cases were placed biliary tract brackets.The patients with nonanastomotic biliary stricture were treated with PTC plus choledochoscope.Results All the 366 patients were followed up for 58.5 (10 to 129) months.Biliary complications after liver transplantation were diagnosed in 42 cases among these patients.The incidence for biliary complications was 11.5％.The univariate analysis and multivariate Logistic regression analysis showed that the second warm ischemia period and the blood loss and the damage of blood supply and the diameter of biliary anastmosis were significantly associated with biliary complications after liver transplantations (Wald =9.474 to 17.208,P ＜ 0.05).Twelve cases with biliary leak were cured through abdominal and nasobiliary drainage.Twenty-two cases with anastomotic biliary stricture were administered sacculus dilatation through ERCP or PTC and were cured,including 6 cases were placed biliary tract brackets.Among 8 cases with nonanastomotic biliary stricture,6 cases were cured through PTC associating with choledochoscope.One case was treated second liver transplantation and another case got worse.Conclusions Ischemic injury and the diameter of anastmosis are risk factors for biliary complications after liver transplantations.The interventional management of biliary stricture and bile leakage after liver transplantation is safe and effective.