Wojcicki Maciej, Milkiewicz Piotr, Silva Michael
Division of Hepatobiliary Surgery and Liver Transplantation, Department of General and Transplant Surgery, M. Curie Hospital, Szczecin, Poland.
Dig Surg. 2008;25(4):245-57. doi: 10.1159/000144653. Epub 2008 Jul 15.
Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10-30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.
胆道并发症仍然是肝移植受者发病的主要原因，全器官移植后发病率为10%-30%，死亡率高达10%。胆漏和胆管狭窄最为常见，但也观察到Oddi括约肌功能障碍、胆道出血和胆道梗阻。胆道并发症可能与多种因素有关，如肝动脉通畅情况、保存损伤、巨细胞病毒感染、慢性胆管减少性排斥反应、ABO血型不相容以及技术原因。后者包括吻合不完善、T管相关并发症以及在实质分割过程中可能发生切面胆漏或意外胆管损伤时使用部分肝移植。在全器官肝移植中使用T管进行胆管对胆管吻合仍存在争议，主要是因为在许多系列研究中观察到T管相关并发症的发生率很高。在本文中，我们根据胆道重建技术和所进行的肝移植手术回顾了病因以及胆道并发症的主要类型。还讨论了它们的处理方法，介入放射学和内镜技术已成为首选治疗方案，在大多数选定患者中无需进行手术。
