摘要目的 研究活体右半供肝移植术后胆道并发症的发生特点和发生胆道狭窄的独立危险因素.方法 回顾性分析2007年4月至2010年4月105例成人活体右半供肝移植受者的临床资料,分析术后胆道并发症的发生率、发生时间及发生胆道狭窄的独立危险因素.结果 105例受者中位随访时间为49.5个月(562～1675 d),术后发生胆道并发症40例(占38.1％),其中胆漏11例(10.4％)和胆道狭窄37例(35.2％).发生胆漏的中位时间为7 d(4～54 d),发生胆道狭窄的中位时间为7.6个月(12～790d),75.7％的胆道狭窄发生在术后1年内.术后1年内胆道狭窄的发生率明显高于术后1年后.胆道狭窄发生的独立危险因素为术后发生胆漏、胆道吻合口径≤3 mm和CMV感染.结论 活体右半供肝移植术后胆道狭窄发生的独立危险因素为胆漏、胆道口径≤3 mm和CMV感染.为减少胆道并发症,术前应充分了解供、受者的胆道情况,术中提高肝移植手术技术、尽量避免损伤胆道供血血管,术后1年内应严密随访、注意预防CMV感染.

abstractsObjective To characterize the clinical course of biliary complications after right lobe living donor liver transplantation (RL-LDLT) and to identify the independent risk factors for biliary strictures.Methods 105 consecutive RL-LDLT recipients operated from April 2007 to April 2010 were followed up. The clinical and operative data were reviewed. The biliary complications and independent risk factors of biliary stricture were studied.Results The median follow-up duration was 49.5 months ranging from 562 to 1675 days.A total of 40 patients (38.1 ％) experienced 11 bile leak episodes (10.4％ ) and 37 (35.2％) biliary stricture episodes after transplantation.Bile leaks occurred at a median time of 9 days ranging from 4 to 54 days after transplantation.For biliary strictures,the occurring time was delayed and scattered wide with a median of 7.6 months ranging from 12 to 790 days after transplantation. Moreover, the biliary stricture incidence in the first year after transplantation was significantly higher than later.The independent risk factors for biliary strictures were CMV infection,bile leaks and bile duct size (≤3 mm).Conclusion The independent risk factors for biliary strictures after RL-LDLT were CMV infection,bile leaks and bile duct size (≤3mm).In order to avoid biliary complications,careful preoperative evaluations are necessary. The dissection of bile ducts should be meticulous to protect its blood supply.CMV infection should be prevented after transplantation.Close surveillance of biliary complications should be given to RL-LDLT recipients during the first year after transplantation.