探讨肝移植术后胆道并发症的诊断与治疗。

回顾性分析2007年8月至2017年8月重庆医科大学附属第一医院收治的14例肝移植术后胆道并发症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男11例，女3例；年龄22～64岁，中位年龄45岁。术式为同种异体背驼式肝移植术，胆管吻合方式为胆管端端吻合。对胆道并发症的诊断、处理和预后进行总结分析。

肝移植术后胆道并发症发生率为12.0%（14/117），其中单纯胆道结石5例，单纯胆管吻合口狭窄4例，缺血性胆道病变2例，单纯胆漏1例，胆漏合并胆管吻合口狭窄、胆道结石合并胆管吻合口狭窄各1例。MRCP确诊6例，ERCP确诊4例，超声检查确诊2例。ERCP治疗7例，胆肠吻合术4例，腹腔引流术1例，广泛肝内胆管缺血性病变再次肝移植1例。治愈好转11例，1例死于肿瘤复发，1例死于胆道感染引起的多器官功能障碍综合征，失访1例。

肝移植术后胆道并发症主要有胆道结石、吻合口狭窄、缺血性胆道病变、胆漏。MRCP为首选诊断方法，ERCP为首选治疗方法，其次为胆肠吻合术，再次肝移植是肝内胆道弥漫性缺血性病变的有效治疗方式。

To investigate the diagnosis and treatments of biliary complications after liver transplantation.

Clinical data of 14 patients with biliary complications after liver transplantation in the First Affiliated Hospital of Chongqing Medical University from August 2007 to August 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 14 patients, 11 cases were male and 3 were female, aged 22-64 years with a median age of 45 years. The allogeneic piggy-back liver transplantation was performed. The bile duct end-to-end anastomosis was applied. The diagnosis, treatments and prognosis of biliary complications were summarized and analyzed.

The incidence of biliary tract complications after liver transplantation was 12.0% (14/117), including 5 cases of simplex biliary calculi, 4 simplex biliary anastomotic stenosis, 2 ischemic biliary tract injury, 1 simplex bile leakage, 1 bile leakage complicated biliary anastomotic stenosis and 1 biliary calculi complicated with biliary anastomotic stenosis. 6 cases were diagnosed by MRCP, 4 by ERCP and 2 by ultrasound. 7 cases were treated by ERCP, 4 by biliary anastomosis, 1 by abdominal drainage and 1 by secondary liver transplantation due to extensive intrahepatic biliary ischemic injury. 11 cases were cured, 1 died from tumor recurrence, 1 died from multiple organ dysfunction syndrome caused by biliary infection, and 1 was lost to follow-up.

Biliary complications after liver transplantation are mainly biliary calculi, anastomotic stenosis, ischemic biliary tract injury and bile leakage. MRCP is the optimal diagnostic method, and ERCP is the preferential treatment, followed by cholecystojejunostomy. Secondary liver transplantation is an effective treatment for diffuse intrahepatic ischemic biliary tract injury.