Pascher Andreas, Neuhaus Peter
Department of General, Visceral, and Transplantation Surgery, Universitätsmedizin Berlin, Berlin, Germany.
Transpl Int. 2005 Jun;18(6):627-42. doi: 10.1111/j.1432-2277.2005.00123.x.
Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of this technique. Biliary complications have been reported to occur at a relatively constant rate of approximately 10-15% of all deceased donor full size OLTs. There is a wide range of potential biliary complications which can occur after OLT. Their incidence varies according to the type of graft, type of donor, and the type of biliary anastomosis performed. The spectrum of biliary complications has changed over the past decade because of the establishment of split liver, reduced-size, and living donor liver transplantation. Apart from technical developments, novel diagnostic methods have been introduced and evaluated in OLT, the most prominent being magnetic resonance imaging (MRI). Treatment modalities have also changed over the past years towards a primarily nonoperative, endoscopy-based strategy, leaving the surgical intervention for lesions which otherwise are not curable. The management of biliary complications after OLT requires a multidisciplinary approach. Conservative, interventional, and endoscopic treatment options have to be weighed up against surgical re-intervention. In the following the spectrum of specific bile duct complications after OLT and their treatment options will be reviewed.
自原位肝移植（OLT）技术开展初期以来，OLT术后涉及胆道的并发症一直是个常见问题。据报道，在所有尸体供肝全尺寸OLT中，胆道并发症的发生率相对稳定，约为10%-15%。OLT术后可能出现多种潜在的胆道并发症。其发生率因移植物类型、供体类型以及所进行的胆道吻合方式而异。由于劈离式肝移植、减体积肝移植和活体供肝肝移植的出现，过去十年间胆道并发症的范围发生了变化。除了技术发展外，OLT中还引入并评估了新的诊断方法，其中最突出的是磁共振成像（MRI）。在过去几年中，治疗方式也转向了以非手术、内镜治疗为主的策略，仅对无法通过其他方式治愈的病变进行手术干预。OLT术后胆道并发症的管理需要多学科方法。必须权衡保守治疗、介入治疗和内镜治疗方案与再次手术干预的利弊。以下将对OLT术后特定胆管并发症的范围及其治疗方案进行综述。
