Velchev L
Khirurgiia (Sofiia). 2008(3):46-52.
Biliary complications after liver transplantation are common and to a great degree define the outcome of the operation. In connection with the frequently observed postoperative complications on this level, Calne RY considers the biliary anastomosis as the "Achilles heel" of the operative intervention. Biliary leaks and strictures in the early postoperative period are a result of technical causes. Late complications have a complex character and mostly occur after occlusion of the hepatic artery, preservation injury, transplant rejection, recurrence of the primary decease and initiation de novo malignant disease. The early diagnosis of the biliary complications is based on the precise observation of the patient's clinical status, of the laboratory levels and of the control ultraconography and cholangiography. The treatment of the biliary complications, diagnosed intraoperatively, is immediate. The early postoperative complications, depending on the type of the performed biliary anastomosis, are mainly treated with nonsurgical methods--endoscopic dilation and stabilizing stent. Late complications, most frequently intrahepatic strictures, require surgical intervention.
肝移植术后胆道并发症很常见,在很大程度上决定了手术的结果。鉴于在这一阶段经常观察到术后并发症,卡尔恩·R·Y认为胆道吻合术是手术干预的“阿喀琉斯之踵”。术后早期的胆漏和狭窄是技术原因造成的。晚期并发症具有复杂的特点,大多发生在肝动脉闭塞、保存损伤、移植排斥、原发性疾病复发和新发恶性疾病之后。胆道并发症的早期诊断基于对患者临床状况、实验室指标以及超声检查和胆管造影检查结果的精确观察。术中诊断出的胆道并发症需立即治疗。术后早期并发症,根据所施行的胆道吻合术类型,主要采用非手术方法治疗——内镜扩张和放置稳定支架。晚期并发症,最常见的是肝内狭窄,则需要手术干预。