肝移植术后胆道并发症的危险因素分析
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周杰 E-mail:jacky@fimmu.com

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Analysis of the risk factors for biliary complications after liver transplantation
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    摘要:

    目的:探讨肝移植术后胆道并发症的临床特点及危险因素。
    方法:回顾性分析施行的172例肝移植患者的临床资料。选取围手术期45个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后胆道并发症相关的危险因素。
    结果:32例发生胆道并发症,患病率为18.6%,包括10例胆瘘,14例无胆瘘的胆管狭窄,5例无胆瘘或胆管狭窄的胆道结石,2例单纯胆道感染,1例单纯胆道出血。其发生的中位时间为22(3~585 d)d。Logistic回归分析显示急性排斥反应(P<0.001),慢性排斥反应(P=0.030),留置T管(P=0.005),术后1个月的肝动脉阻力指数(RI)≤0.66(P=0.026)是术后胆道并发症的独立危险因素。
    结论:肝动脉血流动力学的严密监测、必要的预防性抗凝治疗、规范的抗排斥治疗、不留置T管的胆管重建方式有助于降低胆道并发症发生率。

    Abstract:

    Objective:To investigate the clinical character and risk factors of  biliary complications after liver transplantation.
    Methods:The clinical data of 172 cases undergoing liver transplantation in the five and a half years in Nanfang Hospital were studied retrospectively. Forty-four independent variables were analyzed by univariate analysis and logistic regression to screen out the risk factors.
    Results:Bliary complications occurred in 32 cases(18.6%), including 10 cases of biliary leakage, 14 cases of biliary stricture without leakage, 5 cases of biliary calculi without stricture or leakage, 2 cases of simple biliary infection and 1 case of simple hemobilia. The median occurring time of biliary complications was 22(3-585)d after surgery. Logistic regression analysis showed four independent risk factors related with biliary complications: acute rejection(P<0.001), chronic rejection(P=0.030),  useing T-tube(P=0.005), and the hepatic arterial resistive index(RI) lower than 0.66 one month after transplantation(P=0.026).
    Conclusions:Rigorous monitoring of hepatic arterial flow, preventative anticoagulant therapy, normative antirejection therapy, bile duct reconstruction without T-tube are the keypoints to reduce the incidence of biliary complications.

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唐彬| 王宇| 周杰| 张国伟| 郑志鹏| 田玉伟.肝移植术后胆道并发症的危险因素分析[J].中国普通外科杂志,2011,20(1):1-5.
DOI:10.7659/j. issn.1005-6947.2011.01.001

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  • 收稿日期:2010-09-05
  • 最后修改日期:2010-11-15
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  • 在线发布日期: 2011-01-15