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| 1 | Biliary complications following liver transplantation显示文摘Biliary tract complications are the most common complications after liver transplantation.These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients.Biliary complications remain a major source of morbidity in liver transplant patients,with an incidence of 5%-32%.Post liver transplantation biliary complications include strictures(anastomotic and non-anastomotic),leaks,stones,sphincter of Oddi dysfunction,and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis.The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation.In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation. | Gursimran Kochhar Jose Mari Parungao Ibrahim A Hanouneh Mansour A Parsi | 2013 | World Journal of Gastroenterology2013，19，19： | 41 |
| 2 | Endoscopic management of biliary complications after liver transplantation: An evidence-based review显示文摘Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients. | Carlos Macías-Gómez Jean-Marc Dumonceau | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，6： | 25 |
| 3 | Endoscopic management of biliary strictures after liver transplantation显示文摘Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classifi ed as anastomotic or non-anastomotic strictures according to location and are defi ned by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is signifi cant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT. | Emmanuelle D Williams Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，30： | 20 |
| 4 | Biliary complications after liver transplantation:current perspectives and future strategies显示文摘Importance:Liver transplantation(LT)is a life-saving therapy for patients with end-stage liver disease and with acute liver failure,and it is associated with excellent outcomes and survival rates at 1 and 5 years.The incidence of biliary complications(BCs)after LT is reported to range from 5%to 20%,most of them occurring in the first three months,although they can occur also several years after transplantation.Objective:The aim of this review is to summarize the available evidences on pathophysiology,risk factors,diagnosis and therapeutic management of BCs after LT.Evidence Review:a literature review was performed of papers on this topic focusing on risk factors,classifications,diagnosis and treatment Findings:Principal risk factors include surgical techniques and donor’s characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non-anastomotic biliary strictures.MRCP is the gold standard both for intra-and extrahepatic BCs,while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal.About treatment,endoscopic techniques are the first line of treatment with success rates of 70-100%.The combined success rate of ERCP and PTBD overcome 90%of cases.Biliary leaks often resolve spontaneously,or with the positioning of a stent in ERCP for major bile leaks Conclusions and Relevance:BCs influence morbidity and mortality after LT,therefore further evidences are needed to identify novel possible risk factors,to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques. | Bianca Magro Matteo Tacelli Alessandra Mazzola Filomena Conti Ciro Celsa | 2021 | Hepatobiliary Surgery and Nutrition2021，10，1： | 12 |
| 5 | Management of biliary complications after liver transplantation显示文摘Biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation. | Riccardo Memeo Tullio Piardi Federico Sangiuolo Daniele Sommacale Patrick Pessaux | 2015 | World Journal of Hepatology2015，7，29： | 9 |
| 6 | Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography显示文摘Biliary adverse events following orthotopic liver transplantation(OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance(MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, noninvasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. Onthe basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents(in particular using Gd-EOBDTPA) in order to improve the diagnostic accuracy in the adverse events' detection such as bile leakage and strictures, especially in selected patients with biliaryenteric anastomosis. | Piero Boraschi Francescamaria Donati | 2014 | World Journal of Gastroenterology2014，20，32： | 9 |
| 7 | 联合肝门板的肝门￣空肠吻合术治疗肝移植术后缺血型胆道病变患者显示文摘目的探讨联合肝门板的肝门￣空肠吻合术治疗肝移植术后缺血型胆道病变(ITBL)患者的疗效。方法回顾性分析2008年10月至2009年12月中山大学附属第三医院肝移植中心先后收治的3例ITBL患者的临床资料。男2例,女1例,年龄分别为24、34、36岁,中位年龄34岁。患者均签署知情同意书,符合医学伦理学规定。3例患者发病时间分别为肝移植术后14个月(例1)、3年(例2)、18个月(例3),均以梗阻性黄疸为主要症状,ITBL主要位于左右肝管及其汇合部(局限于肝门部)。采用联合肝门板的肝门￣空肠吻合术。观察3例患者手术及术后并发症等。出院后患者接受定期随访,观察患者预后情况。结果 3例患者手术均成功,术后恢复顺利,无发生胆漏和肠漏等手术相关并发症。例1患者由于肝内胆道缺血型胆道病变进展,在术后病情稳定2年9个月后再次出现ITBL临床表现,拟行再次肝移植;例2患者术后随访3年情况稳定;例3患者术后病情稳定6个月后再次出现严重的ITBL表现,放弃治疗。结论联合肝门板的肝门￣空肠吻合术可用于治疗局限于肝门部且病情稳定的ITBL患者,可延缓或避免再次肝移植手术。 | 易述红 易慧敏 傅斌生 孟炜 李华 许赤 杨扬 陈规划 | 2013 | 中华肝脏外科手术学电子杂志2013，2，1： | 6 |
| 8 | ERCP诊治成人原位肝移植术后胆道并发症的临床研究显示文摘目的 :回顾性分析和评价内镜逆行胰胆管造影(ERCP)在成人原位肝移植胆道并发症诊疗中的作用。方法:38例成人原位肝移植术后胆道并发症患者实施61次ERCP,根据ERCP结果实施内镜治疗。结果:60次ERCP成功,成功率为98.36%(60/61)。ERCP明确胆道并发症原因后实施内镜治疗。并发症发生的部位为:供体肝胆管、受体胆管、胆管吻合口及十二指肠乳头。其中单纯胆管炎性狭窄7例,胆管炎性狭窄伴肝内外胆管铸型、胆泥或胆石形成10例;单纯胆管吻合口狭窄3例,狭窄伴肝内外胆管铸型、胆泥或胆石形成2例;胆管吻合口瘘2例,供体胆管与受体胆管直径差异过大1例;受体胆管过长、扭曲3例,受体胆管轻度扩张1例;十二指肠乳头狭窄2例,Oddi括约肌功能失调3例;T管脱落1例;胆道出血1例;ERCP插管失败1例。该组供体肝胆管并发症发生率最高,为44.74%(17/38);其次为胆管吻合口并发症,为21.05%(8/38)。治疗方式:乳头括约肌切开(EST)24.59%(15/61),乳头柱状球囊扩张(EPBD)16.39%(10/61),EST+EPBD 13.12%(8/61),扩张器扩张胆管36.07%(22/61),鼻胆管引流(ENBD)52.46%(32/61),胆管支架引流(ERBD)32.79%(20/61),取胆管铸型、胆泥或结石19.67%(12/61),胆道冲洗24.59%(15/61)。结论:ERCP具有诊疗一体化优点,已成为成人原位肝移植术后胆道并发症微创治疗的主要方法和重要治疗手段。 | 田虎 杨玉龙 张锎 冯秋实 | 2014 | 中国现代普通外科进展2014，17，11： | 5 |
| 9 | 内镜下逆行胰胆管造影术在肝移植术后胆道并发症中的应用显示文摘目的探讨内镜下逆行胰胆管造影术(ERCP)在治疗肝移植术后胆道并发症方面的临床疗效。方法回顾性分析中山大学附属第一医院器官移植中心2005年2月至2010年2月采用ERCP治疗68例肝移植术后胆道并发症患者的临床资料。68例患者中胆道狭窄44例,其中吻合口狭窄28例,非吻合口狭窄16例;胆漏11例;胆泥和胆石形成25例,其中合并胆道狭窄12例。对胆道狭窄患者行括约肌切开、胆管扩张、鼻胆管引流和塑料内支架置放术等治疗;对胆漏患者行鼻胆管引流及塑料内支架置放术等治疗;对结石患者行括约肌切开、鼻胆管冲洗引流术及取石网篮取石等治疗。结果 ERCP手术成功率为94.4%(169/179),严重并发症的发生率低。吻合口狭窄的治愈率为96.4%(27/28),非吻合口狭窄的治愈率为25.0%(4/16),胆漏的治愈率为81.8%(9/11),结石患者的结石清除率为80.0%(20/25)。结论 ERCP是治疗肝移植术后胆道并发症安全、有效的方法。 | 鞠卫强 何晓顺 邰强 巫林伟 郭志勇 王东平 朱晓峰 黄洁夫 | 2011 | 中华临床医师杂志(电子版)2011，5，6： | 5 |
| 10 | 肝移植术后胆道并发症的内镜治疗显示文摘目的:探讨内镜下逆行胰胆管造影术(ERCP)在治疗肝移植术后胆道并发症方面的临床疗效。方法:回顾性分析2002年8月—2012年12月采用ERCP治疗8例肝移植术后胆道并发症患者的临床资料,其中胆道狭窄5例(吻合口狭窄4例,肝内型胆道狭窄1例),胆瘘1例,胆石和胆泥形成2例。8例患者共行ERCP治疗21次,对胆道狭窄患者行括约肌切开、胆管扩张、鼻胆管引流和内支架置放术等治疗;对胆瘘患者行鼻胆管引流及塑料内支架置放术等治疗;对结石患者行括约肌切开、鼻胆管冲洗引流术及取石网篮取石等治疗。结果:ERCP手术成功率为100%(21/21);4例吻合口狭窄、1例胆瘘和2例结石患者均治愈,1例肝内型胆道狭窄治疗未成功,建议再次肝移植;术后胆道感染的发生率为14.3%(3/21),胰腺炎发生率为19.0%(4/21),经对症治疗后均痊愈。结论:ERCP是治疗肝移植术后胆道并发症微创、安全和有效的方法。 | 肖建生 万仁华 高良辉 李剑锋 单人锋 叶啟发 | 2013 | 中国普通外科杂志2013，22，7： | 5 |
| 11 | 肝移植术后胆道并发症研究进展显示文摘肝移植术后胆道并发症(BC)一般指肝移植术后胆道异常导致肝功能恢复异常或胆汁代谢异常情况的统称。近年来,随着内镜技术的不断发展,内窥镜治疗已成为肝移植术后BC的主要治疗方式。BC是评估肝移植术后疗效的重要指标,与术前供肝保存、术中手术操作和术后免疫排斥反应等诸多因素密切相关。本文对近年来肝移植术后BC分类、机制、诊断、预防及治疗进行综述。 | 陈非凡 赵红川 | 2021 | 中华移植杂志(电子版)2021，15，4： | 4 |
| 12 | 成人原位肝移植术后胆道并发症的内镜诊断和治疗显示文摘目的探讨成人原位肝移植术后胆道并发症的内镜逆行胰胆管造影(ERCP)表现和内镜治疗方法,评估ERCP和内镜治疗的作用。提高肝移植的手术疗效和改善患者的生存质量,延缓二次肝移植时间。方法 20例成人原位肝移植术后胆道并发症患者实施32次ERCP,并根据ERCP结果实施相应治疗。结果 19例31次获得成功,ERCP成功率为96.88%(31/32)。全组病人ERCP后明确胆道并发症原因,并发症发生的部位为:供体肝、供体及受体胆管、胆管吻合口及十二指肠乳头。其中胆管炎性狭窄5例,胆管炎性狭窄伴肝内外胆管胆泥或胆石形成3例,胆管吻合口狭窄3例,十二指肠乳头功能紊乱2例,十二指肠乳头狭窄2例,胆管过长、扭曲2例,供体胆管与受体胆管直径差异过大1例,胆总管轻度扩张1例。本组无胆漏及胆道出血患者,胆管炎性狭窄发生率最高,为40%(8/20);其次为胆管吻合口狭窄,为15%(3/20)。内镜治疗治愈率为60%(12/20),好转率为35%(7/20)。治疗方式选择:乳头扩张12.50%(4/32),乳头括约肌切开37.50%(12/32),胆管扩张43.75%(14/32),鼻胆管引流68.75%(22/32),胆管支架引流28.12%(9/32),取石12.50%(4/32),胆管冲洗31.25%(10/32)。结论内镜治疗已成为成人原位肝移植术后胆道并发症非手术治疗的首选方式和主要方法。 | 田虎 郭源 李志强 滕木俭 李杰 胡宗泽 | 2010 | 肝胆外科杂志2010，18，5： | 3 |
| 13 | 治疗性内镜逆行胰胆管造影在成人原位肝移植术后胆道并发症的应用显示文摘目的探讨成人原位肝移植术后胆道并发症的内镜逆行胰胆管造影(ERCP)表现和内镜治疗方法,评估治疗性ERCP的作用和地位。方法 22例成人原位肝移植术后胆道并发症患者实施34次ERCP,并根据ERCP结果实施相应内镜治疗。结果 21例33次获得成功,ERCP成功率为97.06%(33/34)。全组患者ERCP后明确胆道并发症原因,并发症发生的部位为:供体肝、供体及受体胆管、胆管吻合口及十二指肠乳头。其中胆管炎性狭窄5例,胆管炎性狭窄伴肝内外胆管胆泥或胆石形成3例,胆管吻合口狭窄3例,十二指肠乳头功能紊乱2例,十二指肠乳头狭窄2例,胆管过长、扭曲2例,吻合口胆漏2例,供体胆管与受体胆管直径差异过大1例,胆总管轻度扩张1例。该组无胆道出血患者,其中胆管炎性狭窄发生率最高,为36.36%(8/22);其次为胆管吻合口狭窄,为13.64%(3/22)。内镜治疗治愈率为63.64%(14/22),好转率为31.82%(7/22)。治疗方式选择:乳头球囊扩张(EPBD)17.65%(6/34),乳头括约肌切开EST35.29%(12/34),扩张胆管41.18%(14/34),鼻胆管引流(ENBD)70.59%(24/34),胆管支架引流(ERBD)26.47%(9/34),取石11.76%(4/34),胆管冲洗29.41%(10/34)。结论治疗性ERCP已成为成人原位肝移植术后胆道并发症非手术治疗的首选方式和主要方法,具有创伤小、治疗效果可靠、诊疗一体化等优点,逐渐成为肝移植术后胆道并发症的重要治疗手段。 | 田虎 冯秋实 郭源 滕木俭 李志强 | 2010 | 中国内镜杂志2010，16，11： | 3 |
| 14 | 减少肝移植术后胆道缺血性损伤的临床路径显示文摘目的:针对肝移植术后并发症缺血性胆道损伤(ITBL),试图建立区分各种导致ITBL的危险因素的临床路径,降低ITBL的发生率。方法:记录随访335例行原位肝移植术(OLT)病例的可能导致胆道缺血的危险因素,包括供肝热缺血时间、冷缺血时间、温缺血时间及供肝脂肪肝情况等。按照冷缺血时间分两组I:TBL组和正常组。比较其他危险因素在两组间的差别。结果:冷缺血时间控制〈8 h,正常组81例,ITBL组2例,热缺血时间差别有统计学意义(P=0.017);8~12 h,正常组150例I,TBL组25例,胆道温缺血时间差异有统计意义(P=0.033);〉12 h,正常组57例I,TBL组20例,供肝脂肪肝发生率差异有统计学意义(P〈0.05)。结论:为避免ITBL,冷缺血时间〈8 hI,TBL的发生率很低,只要控制好热缺血时间即可;冷缺血时间8~12 h,尽量将胆道温缺血时间控制在1 h左右;冷缺血时间〉12 h,对于有严重脂肪变的边缘供体可以考虑弃用。 | 范宁 臧运金 陈新国 王建立 刘煜 吴凤东 邹卫龙 沈中阳 | 2011 | 中国现代普通外科进展2011，14，7： | 3 |
| 15 | Prevent bile duct injury by indocyanine green guide fluorescent imaging during laparoscopic cholecystectomy in liver transplantation recipient显示文摘Cholecystolithiasis with acute cholecystitis is a rare,late biliary complication occurring in liver transplantation(LT)recipients who received the liver graft with preserved donor’s gallbladder.Although laparoscopic cholecystectomy(LC)is not contraindicated after upper abdominal surgery,misunderstanding of the biliary anatomy due to inflammatory phenomena or severe adhesion might increase the risk of bile duct injury(BDI)(1). | Chee-Chien Yong Shih-Min Yin Yi-Ping Sng Chao-Long Chen | 2020 | Hepatobiliary Surgery and Nutrition2020，9，6： | 2 |
| 16 | Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy显示文摘 | Hu Tian Qian-De Liao Nian-Feng Li Jian Peng Lian-Sheng Gong Ju Liu | 2015 | Chinese Medical Journal2015，，14： | 2 |
| 17 | 成人肝移植术后胆道并发症的诊治分析显示文摘目的探讨原位肝移植术后胆道并发症的诊断及有效治疗方法。方法回顾分析2004年8月至2011年12月施行的253例次原位肝移植(其中2例次为二次肝移植)的临床资料,对35例次胆道并发症的诊断及治疗经验进行总结分析。结果 253例次原位肝移植,其中35例次发生胆道并发症,发生率为13.8%,其中胆道狭窄21例(60%),包括胆管吻合口狭窄13例(6例合并有胆道结石/胆泥),非吻合口胆管狭窄8例;胆漏12例(34.2%),其中4例合并有吻合口狭窄;胆道出血2例(5.7%)。35例次患者中行ERCP处理17例次(48.6%),治愈及好转26例次(74.3%),1例次行二次肝移植,死亡2例次。结论胆道并发症首先应考虑非手术治疗(包括ERCP),而非手术治疗效果不佳的患者,再次手术胆道探查是必要的治疗手段,对于严重胆道损伤导致移植物功能丢失,二次肝移植是唯一的选择。 | 李湘竑 罗振超 林建华 崔忠林 周杰 | 2012 | 肝胆外科杂志2012，20，6： | 1 |
| 18 | What is the current role of endoscopy in primary sclerosing cholangitis?显示文摘Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold standard.In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC. | Benjamin Tharian Nayana Elizabeth George Tony Chiew Keong Tham | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，10： | 1 |
| 19 | 肝移植术后胆管并发症内镜治疗进展显示文摘肝移植仍然是目前终末期肝病或急性肝衰竭患者的最终治疗方案。随着器官保存、新型免疫抑制剂、围术期管理及肝胆外科技术的改善和发展,肝移植术后并发症的发生率已经显著减少,但是肝移植术后胆管并发症的治疗仍然面临诸多挑战,成为影响肝移植患者术后生活质量和生存时间的主要因素。肝移植术后胆管并发症包括胆管狭窄、吻合口漏和胆管结石等,治疗方法包括药物、内镜、肝穿刺胆管引流和手术等。随着内镜逆行胰胆管造影技术的飞速发展和广泛应用,操作的成功率高达90%~98%。因为内镜逆行胰胆管造影具有价格低、侵入性小、安全性相对较高等性价比优势,已经成为治疗肝移植术后胆管并发症的一线治疗方案。 | 徐辉 李冰 | 2018 | 临床肝胆病杂志2018，34，10： | 1 |
| 20 | 保留供肝胃十二指肠动脉对肝移植术后胆道并发症的影响显示文摘目的探讨保留供肝胃十二指肠动脉的改良供肝修剪方法对肝移植受者术后胆道并发症的影响。方法回顾性分析2011年9月至2019年11月在佛山市第一人民医院行原位肝移植的129例受者临床资料。其中男120例,女9例;年龄31~71岁,中位年龄50岁。受者均签署知情同意书,符合医学伦理学规定。根据供肝修剪方法,将受者分为改良组(56例)和常规组(73例)。改良组技术要点是保留胃十二指肠动脉远端至少2 cm,特别注意保留胰十二指肠上动脉后支以及变异的肝右动脉,以保证胆总管远端血供。观察两组肝移植围手术期情况。两组手术时间比较采用t检验,术后住院时间比较采用Mann-Whitney U检验,术后胆道并发症发生率比较采用χ^(2)检验。结果改良组平均手术时间为(7.4±1.2)h,明显少于常规组的(8.0±1.3)h(t=-2.524,P<0.05)。改良组术后住院时间分别为16(14)d,明显少于常规组的22(11)d(Z=2.970,P<0.05)。改良组术后胆道并发症发生率为5%(3/56),明显低于常规组的21%(15/73)(χ^(2)=6.091,P<0.05)。结论保留供肝胃十二指肠动脉的改良修肝方法可保持胰十二指肠上后动脉及周围组织的完整性,有利于保护肝外胆管的血供,降低肝外胆管缺血所导致的肝移植术后胆道并发症发生率。 | 陈焕伟 刘颖 廖珊 邓斐文 王峰杰 | 2021 | 中华肝脏外科手术学电子杂志2021，10，6： | 0 |
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