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高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略

田青山 冯少培 郭亚民 韩秀敏 赵顺云 叶成杰 安永德 吴世乐 王向前 郑海波 朱文君 阿吉德 高伟 潘洪帅

田青山,冯少培,郭亚民,等. 高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略[J]. 临床肝胆病杂志, 2021, 37(9): 2153-2160. DOI: 10.3969/j.issn.1001-5256.2021.09.029
引用本文: 田青山,冯少培,郭亚民,等. 高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略[J]. 临床肝胆病杂志, 2021, 37(9): 2153-2160. DOI: 10.3969/j.issn.1001-5256.2021.09.029
TIAN QS, FENG SP, GUO YM, et al. Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies[J]. J Clin Hepatol, 2021, 37(9): 2153-2160. DOI: 10.3969/j.issn.1001-5256.2021.09.029
Citation: TIAN QS, FENG SP, GUO YM, et al. Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies[J]. J Clin Hepatol, 2021, 37(9): 2153-2160. DOI: 10.3969/j.issn.1001-5256.2021.09.029

高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略

DOI: 10.3969/j.issn.1001-5256.2021.09.029
基金项目: 

青海省2020年重大公共卫生专项资金包虫病防治项目 2305999901-1073

详细信息
    通讯作者:

    郭亚民,gym135@yeah.net

    田青山与冯少培对本文贡献相同,同为第一作者

    田青山与冯少培对本文贡献相同,同为第一作者

  • 中图分类号: R532.32;R617

Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies

Funds: 

Project of Echinococcosis Prevention and Control with Special Fund for Major Public Health in Qinghai Province in 2020 2305999901-1073

  • 摘要:   目的  探讨高原地区体外肝切除联合自体肝移植术治疗终末期肝泡型包虫病的术后并发症并探讨防治策略。  方法  收集青海省人民医院2013年1月— 2019年3月接受自体肝移植术的11例终末期肝泡型包虫病患者的手术资料及随访资料,对术中及术后情况进行分析。  结果  11例患者均成功行自体肝移植术,无术中死亡,其中2例(18.18%)行半离体肝切除,9例(81.82%)行全离体肝切除。肝后下腔静脉重建方式中,采用自体大隐静脉进行重建者2例(18.18%),采用人造血管重建者4例(36.36%),5例(45.45%)保留自体肝后下腔静脉。胆道重建方式中,8例(72.73%)行胆肠吻合术,3例(27.27%)行胆管端端吻合术。11例患者的术后并发症主要有出血2例(18.18%);胆汁漏、腹腔感染4例(36.36%),胆肠吻合口狭窄1例(9.09%), 血栓2例(18.18%),肺部感染、胸腔积液2例(18.18%);包虫复发1例(9.09%)。11例患者发生围术期死亡2例(18.18%),其余9例(81.82%)患者均好转出院。  结论  出血、胆道并发症和感染是造成高原地区自体肝移植患者死亡的主要原因,精准把握手术适应证、术前仔细多学科评估、术中精湛的操作、外科技术流程的标准化及精细的围术期管理是降低自体肝移植术围术期病死率、避免和减少术后并发症以及使患者获得长期良好生存的关键。

     

  • 图  1  ELRA部分手术过程

    注:a,探查腹腔及病灶位置;b,切除的肝脏置于放有冰块的修肝盆中,内衬无菌塑料膜(将冰块与肝脏隔开),用4 ℃的灌洗液通过门静脉行肝脏灌洗,沿正常肝组织边缘完整切除病灶,然后进行修肝;c,人工血管重建肝后下腔静脉并与肝静脉吻合;d,吻合肝动脉。

    图  2  晚期HAE患者术前CT影像评估结果

    注:a,包虫侵犯第一、第二肝门(箭头所示);b,包虫病灶紧邻心包,下腔静脉受侵(箭头所示);c,CT三维重建显示肝脏全貌(正面);d,包虫病灶与下腔静脉、门静脉、肝动脉位置关系(背面)。

    表  1  11例行ELRA的晚期HAE患者一般资料

    患者编号 性别 年龄(岁) 民族 BMI (kg/m2) 远隔转移 合并乙型肝炎 临床表现 减黄措施
    黄疸 腹痛 下肢水肿
    1 19 22.15
    2 62 21.33
    3 50 23.39
    4 45 20.96 药物
    5 37 20.08 PTCD
    6 21 21.78 PTCD
    7 46 21.55 药物
    8 33 18.94
    9 19 19.38
    10 34 21.09
    11 36 23.83 药物
    注:PTCD,经皮肝穿刺胆道引流术。
    下载: 导出CSV

    表  2  11例行ELRA的晚期HAE患者术前评估结果

    患者编号 术前Child- Pugh分级 WHO- IWGE PNM分型 XJHCRI PIVM分型 血管侵犯 外周侵犯 吲哚菁绿15分钟滞留率(%) 标准肝体积(ml) 40% SLV(ml) CT三维移植肝体积(ml) CT三维病灶体积(ml) 残肝比(%)
    1 A P3N1M1 PⅠ、Ⅳ-Ⅷ I1V1M2 第二、三肝门、肝后下腔静脉 右侧膈肌、右肾上级、右侧肾上腺、肺 10 978.47 391.39 750.6 4 386.0 12.9
    2 A P2N1M0 PⅠ-Ⅷ I2V1M1 第一、二肝门、肝后下腔静脉 右侧膈肌、右侧肾上腺 8 886.41 354.56 1 453.0 1 495.4 41.5
    3 B P2N1M0 PⅠ-Ⅳ、Ⅷ I1V1M1 第一、二、三肝门,肝右静脉及肝后下腔静脉 双侧膈肌、右肾上级、右侧肾上腺 11 1 139.58 455.83 1 123.6 700.0 51.1
    4 A P4N1M0 PⅠ、Ⅳ-Ⅷ I1V1M1 第一、二、三肝门,肝左静脉及肝后下腔静脉 右侧膈肌 5 1 047.52 419.01 1 099.3 2 317.9 29.4
    5 A P4N1M1 PⅤ-Ⅷ 11V1M2 第二、三肝门、肝后下腔静脉 右侧膈肌、肺 3.5 955.46 382.18 1 137.8 2 159.3 29.4
    6 B P4N1M0 PⅡ-Ⅳ I2V1M0 第二、三肝门、肝后下腔静脉 9 943.95 377.58 1 312.3 779.5 54.0
    7 A P3N0M0 PⅣ-Ⅷ I2V1M0 第二、三肝门、肝后下腔静脉 4 1 093.55 437.42 788.5 969.3 31.7
    8 A P3N1M0 PⅠ-Ⅴ、Ⅷ I1V1M1 第一、二肝门及肝后下腔静脉 右侧膈肌 5.5 1 001.49 400.59 801.1 736.5 69.7
    9 A P3N1M0 PⅡ-Ⅵ I1V1M1 第一、二、三肝门、肝后下腔静脉 右侧膈肌 4 897.92 359.17 2 507.5 4 047.1 16.5
    10 A P3N1M0 PⅠ、Ⅳ、Ⅴ、Ⅷ I1V1M1 第一、二、三肝门、肝后下腔静脉 右侧膈肌 3.5 955.46 382.18 930.5 907.5 73.4
    11 A P3N0M0 PⅠ、Ⅳ、Ⅴ、Ⅶ、Ⅷ I2V1M0 第二、三肝门、肝后下腔静脉 8 1 036.01 414.41 801.1 1 669.5 35.8
    注:WHO-IWGE:世界卫生组织包虫病专家工作组;XJHCRI:新疆维吾尔自治区包虫病临床研究所。
    下载: 导出CSV

    表  3  11例行ELRA的HAE患者手术情况

    患者编号 术中出血(ml) 术中输红细胞悬液(U) 术中输血浆(ml) 手术时长(min) 无肝期时长(min) 病灶最大直径(cm) 含病灶切除肝重量(g) 移植肝重量(g) 手术方式
    1 600 4 600 546 273 20 5811 640 离体肝切除+肝后下腔静脉移植+自体肝移植术
    2 12 000 60 4300 729 366 16 2110 1380 离体肝切除+自体肝移植术
    3 11 000 39 4300 964 451 18 2993 1010 离体肝切除+肝后下腔静脉移植+同种异体肝静脉移植+自体肝移植术
    4 3000 6 950 607 187 18 4132 1300 离体肝切除+肝后下腔静脉移植+同种异体肝静脉移植+自体肝移植术
    5 6000 20 2730 693 0 16 2500 1260 半离体肝切除+自体肝移植术
    6 5000 20 2060 663 0 12 4132 1300 半离体肝切除+自体肝移植术
    7 2600 5 1350 1070 430 16 1580 690 离体肝切除+自体肝移植术
    8 2300 6 2020 835 344 16 905 1810 离体肝切除+自体肝移植术
    9 2500 2 600 765 345 14 5932 730 离体肝切除+自体肝移植术
    10 1200 6 5401 875 403 8 1030 2400 离体肝切除+自体肝移植术
    11 2600 4 2280 900 467 18 1700 900 离体肝切除+肝后下腔静脉移植+自体肝移植术
    下载: 导出CSV

    表  4  11例ELRA患者的胆道重建方式、肝后下腔静脉重建方式与术后并发症及预后情况

    患者编号 总住院天数(d) 术后住院天数(d) 胆道重建方式 肝后下腔静脉重建方式 术后并发症 预后
    1 44 30 胆肠吻合 人造血管 腹水、低蛋白血症 存活
    2 23 2 胆肠吻合 保留自体肝后下腔静脉 腹腔活动性出血、低血容量性休克、DIC、代谢性酸中毒、电解质紊乱 死亡
    3 47 36 胆肠吻合 人造血管 胆汁漏、腹腔感染、感染性休克、脓毒血症、多脏器功能衰竭 死亡
    4 43 29 左肝管与胆总管端端吻合及T管引流 人造血管 胆汁漏、腹腔感染、感染性休克、脓毒血症、多脏器功能衰竭、门静脉血栓、凝血功能紊乱、混合型酸碱平衡紊乱、肝性脑病、肺部感染、低蛋白血症、电解质紊乱 死亡
    5 38 24 胆肠吻合 大隐静脉 右侧胸腔积液、腹水、低蛋白血症 存活
    6 38 19 胆肠吻合 大隐静脉 胆肠吻合口狭窄、急性胆管炎、肝脓肿、肺部感染、胸腔积液、低蛋白血症 存活
    7 112 19 胆肠吻合 保留自体肝后下腔静脉 梗阻性黄疸、肺部感染、双侧胸腔积液 存活
    8 29 19 胆肠吻合 保留自体肝后下腔静脉 包虫复发、右侧胸腔积液 存活
    9 55 44 右肝管与胆总管端端吻合及T管引流 保留自体肝后下腔静脉 胆汁漏、腹腔感染、腹腔脓肿、急性肝功能损害、腹水、低蛋白血症、肺部感染、右侧胸腔积液、菌血症 存活
    10 53 23 左肝管与胆总管端端吻合及T管引流 保留自体肝后下腔静脉 胆汁漏、肝周脓肿、局限性腹膜炎、腹腔积液、下腔静脉血栓 存活
    11 69 26 胆肠吻合 人造血管 胆道出血、凝血功能紊乱、右侧胸腔积液 死亡
    下载: 导出CSV
  • [1] LI T, CHEN X, ZHEN R, et al. Widespread co-endemicity of human cystic and alveolar echinococcosis on the eastern Tibetan Plateau, northwest Sichuan/southeast Qinghai, China[J]. Acta Trop, 2010, 113(3): 248-256. DOI: 10.1016/j.actatropica.2009.11.006.
    [2] WANG JL, LI TT, HUANG SY, et al. Major parasitic diseases of poverty in mainland China: Perspectives for better control[J]. Infect Dis Poverty, 2016, 5(1): 67. DOI: 10.1186/s40249-016-0159-0.
    [3] DEPLAZES P, RINALDI L, ROJAS CA, et al. Global distribution of alveolar and cystic echinococcosis[J]. Adv Parasitol, 2017, 95: 315-493. DOI: 10.1016/bs.apar.2016.11.001.
    [4] ZHAO J, DAWA Y, A K, et al. Association between echinococcosis-specific health literacy and behavioural intention to prevent echinococcosis among herdsmen on the Tibet Plateau in China: A cross-sectional study[J]. BMC Infect Dis, 2021, 21(1): 101. DOI: 10.1186/s12879-021-05775-8.
    [5] SALM LA, LACHENMAYER A, PERRODIN SF, et al. Surgical treatment strategies for hepatic alveolar echinococcosis[J]. Food Waterborne Parasitol, 2019, 15: e00050. DOI: 10.1016/j.fawpar.2019.e00050.
    [6] BRUNETTI E, KERN P, VUITTON DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans[J]. Acta Trop, 2010, 114(1): 1-16. DOI: 10.1016/j.actatropica.2009.11.001.
    [7] MIHMANLI M, IDIZ UO, KAYA C, et al. Current status of diagnosis and treatment of hepatic echinococcosis[J]. World J Hepatol, 2016, 8(28): 1169-1181. DOI: 10.4254/wjh.v8.i28.1169.
    [8] PARSAK CK, DEMIRYUREK HH, INAL M, et al. Alveolar hydatid disease: Imaging findings and surgical approach[J]. Acta Chir Belg, 2007, 107(5): 572-577. DOI: 10.1080/00015458.2007.11680128.
    [9] GUO YM, ZHU WJ, ZHAO SY, et al. Surgical treatment strategy for complex hepatic echinococcosis: A review[J]. Chin J Schisto Control, 2018, 30(6): 705-708. DOI: 10.16250/j.32.1374.2018169.

    郭亚民, 朱文君, 赵顺云, 等. 复杂性肝棘球蚴病外科治疗策略研究进展[J]. 中国血吸虫病防治杂志, 2018, 30(6): 705-708. DOI: 10.16250/j.32.1374.2018169.
    [10] KERN P, WEN H, SATO N, et al. WHO classification of alveolar echinococcosis: Principles and application[J]. Parasitol Int, 2006, 55 (Suppl): s283-s287. DOI: 10.1016/j.parint.2005.11.041.
    [11] Chinese Doctor Association, Chinese College of Surgeons(CCS), Chinese Committee for Hadytidology(CCH). Expert consensus on diagnosis and treatment of hepatic cystic and alveolar echinococcosis (2019 edition)[J]. Chin J Dig Surg, 2019, 18(8): 711-721. DOI: 10.3760/cma.j.issn.1673-9752.2019.08.002.

    中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(8): 711-721. DOI: 10.3760/cma.j.issn.1673-9752.2019.08.002.
    [12] SULIMA M, NAHORSKI W, GORYCKI T, et al. Ultrasound images in hepatic alveolar echinococcosis and clinical stage of the disease[J]. Adv Med Sci, 2019, 64(2): 324-330. DOI: 10.1016/j.advms.2019.04.002.
    [13] YE QF, LI X, FAN XL, et al. Research on the indications of half in situ or ex situ liver resection and liver autotransplantation: A report 36 cases[J]. Chin J Pract Surg, 2014, 34(8): 749-753. DOI: 10.7504/CJPS.ISSN1005-2208.2014.08.21.

    叶啟发, 李弦, 范晓礼, 等. 半离体或离体肝切除联合自体肝移植适应证探讨(附36例报告)[J]. 中国实用外科杂志, 2014, 34(8): 749-753. DOI: 10.7504/CJPS.ISSN1005-2208.2014.08.21.
    [14] AJI T, DONG J, SHAO Y, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis[J]. J Hepatol, 2018, 69(5): 1037-1046. DOI: 10.1016/j.ijid.2018.11.016.
    [15] SHI ZR, YAN LN, LI B, et al. Evaluation of standard liver volume formulae for Chinese adults[J]. World J Gastroenterol, 2009, 15(32): 4062-4066. DOI: 10.3748/wjg.15.4062.
    [16] SHEN S, QIU Y, YANG X, et al. Remnant liver-to-standard liver volume ratio below 40% is safe in ex vivo liver resection and autotransplantation[J]. J Gastrointest Surg, 2019, 23(10): 1964-1972. DOI: 10.1007/s11605-018-4022-4.
    [17] YANG X, QIU Y, HUANG B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases[J]. Am J Transplant, 2018, 18(7): 1668-1679. DOI: 10.1111/ajt.14621.
    [18] PICHLMAYR R, BRETSCHNEIDER HJ, KIRCHNER E, et al. Ex situ operation on the liver. A new possibility in liver surgery[J]. Langenbecks Arch Chir, 1988, 373(2): 122-126. DOI: 10.1007/BF01262775.
    [19] KATO T, HWANG R, LIOU P, et al. Ex vivo resection and autotransplantation for conventionally unresectable tumors - an 11-year single center experience[J]. Ann Surg, 2020, 272(5): 766-772. DOI: 10.1097/SLA.0000000000004270.
    [20] HWANG R, LIOU P, GRIESEMER A, et al. Ex vivo tumor resection and intestinal autotransplantation - a single center 10-year experience[J]. Transplantation, 2019, 103: s25. DOI: 10.1097/01.tp.0000575548.39884.0b.
    [21] HWANG R, LIOU P, KATO T. Ex vivo liver resection and autotransplantation: An emerging option in selected indications[J]. J Hepatol, 2018, 69(5): 1002-1003. DOI: 10.1016/j.jhep.2018.09.005.
    [22] WEN H, DONG JH, ZHANG JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: A case series[J]. Am J Transplant, 2016, 16(2): 615-624. DOI: 10.1111/ajt.13465.
    [23] YANG XW, HUANG B, QIU YW, et al. Ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis: A report of 21 cases[J]. Chin J Bases and Clin Gen Surg, 2017, 24(6): 685-690. DOI: 10.7507/1007-9424.201704040.

    杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道[J]. 中国普外基础与临床杂志, 2017, 24(6): 685-690. DOI: 10.7507/1007-9424.201704040.
    [24] GAO C, YE CJ, GUO YM, et al. Analysis of postoperative complications after autologous liver transplantation in hepatic alveolar echinococcosis patients from plateau area[J]. Organ Transplantion, 2016, 7(6): 449-453. DOI: 10.3969/j.issn.1674-7445.2016.06.007.

    高超, 叶成杰, 郭亚民, 等. 高原肝泡状棘球蚴病自体肝移植术后并发症的分析[J]. 器官移植, 2016, 7(6): 449-453. DOI: 10.3969/j.issn.1674-7445.2016.06.007.
    [25] YU ZS, JIANG Y, CAI QC, et al. Complications after liver transplantation[J]. Chin J Tissue Engineer Res, 2013, 17 (18): 3275-3282. DOI: 10.3969/j.issn.2095-4344.2013.18.007.

    余忠山, 江艺, 蔡秋程, 等. 肝移植后的并发症[J]. 中国组织工程研究, 2013, 17(18): 3275-3282. DOI: 10.3969/j.issn.2095-4344.2013.18.007.
    [26] YE XZH, WU XM, MA RH, et al. Autologous liver transplantation for the treatment of end-stage alveolar echinococcosis in plateau area[J]. Chin J Hepatobiliary Surg, 2014, 20 (2): 148-150. DOI: 10.3760/cma.j.issn.1007-8118.2014.02.018.

    叶谢智华, 吴新民, 马荣花, 等. 高原地区自体肝移植治疗终末期泡型肝包虫病[J]. 中华肝胆外科杂志, 2014, 20(2): 148-150. DOI: 10.3760/cma.j.issn.1007-8118.2014.02.018.
    [27] CHENG HH, A XR, WANG LP. Changes of vascular endothelial cell function in healthy people at different altitudes[J]. Lab Med, 2010, 25 (8): 647-648. DOI: 10.3969/j.issn.1673-8640.2010.08.020.

    程海花, 阿祥仁, 王立萍. 不同海拔地区健康人群血管内皮细胞功能指标的变化[J]. 检验医学, 2010, 25(8): 647-648. DOI: 10.3969/j.issn.1673-8640.2010.08.020.
    [28] ZENG DF, WANG J. Traumatic coagulation abnormalities and trauma induced coagulopathy in high altitude environment[J/CD]. Chin J Diag (Electronic Edition), 2020, 8(3): 168-170. DOI: 10.3877/cma.j.issn.2095-655X.2020.03.005.

    曾东风, 王劲. 高原环境下创伤后凝血功能异常与创伤性凝血病[J/CD]. 中华诊断学电子杂志, 2020, 8(3): 168-170. DOI: 10.3877/cma.j.issn.2095-655X.2020.03.005.
    [29] QIAN HG, GONG BCD, FAN JL, et al. Changes of coagulation function and its significance in patients with multiple organ dysfunction syndromes (MODS)after serious trauma at high altitude[J]. J High Altitude Med, 2011, 21 (3): 1-4. DOI: 10.3969/j.issn.1007-3809.2011.03.001.

    钱惠岗, 公保才旦, 樊建林, 等. 高原地区严重创伤后多脏器功能不全患者凝血功能的变化及意义[J]. 高原医学杂志, 2011, 21(3): 1-4. DOI: 10.3969/j.issn.1007-3809.2011.03.001.
    [30] ZHU ZD, DU GS, SHI BY, et al. Upper gastrointestinal bleeding after adults orthotopic liver transplantation[J]. J Clin Rehabil Tissue Eng Res, 2011, 15 (53): 9893-9896. DOI: 10.3969/j.issn.1673-8225.2011.53.004.

    朱志东, 杜国盛, 石炳毅, 等. 成人肝移植后的上消化道出血[J]. 中国组织工程研究与临床康复, 2011, 15(53): 9893-9896. DOI: 10.3969/j.issn.1673-8225.2011.53.004.
    [31] Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)[J]. Ogran Transplantation, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002.

    中华医学会器官移植学分会. 中国肝移植术后并发症诊疗规范(2019版)[J]. 器官移植, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002.
    [32] LATTANZI B, OTT P, RASMUSSEN A, et al. Ischemic damage represents the main risk factor for biliary stricture after liver transplantation: A follow-up study in a danish population[J]. In Vivo, 2018, 32(6): 1623-1628. DOI: 10.21873/invivo.11423.
    [33] JUNG DH, IKEGAMI T, BALCI D, et al. Biliary reconstruction and complications in living donor liver transplantation[J]. Int J Surg, 2020, 82S: 138-144. DOI: 10.1016/j.ijsu.2020.04.069.
    [34] SIMOES P, KESAR V, AHMAD J. Spectrum of biliary complications following live donor liver transplantation[J]. World J Hepatol, 2015, 7(14): 1856-1865. DOI: 10.4254/wjh.v7.i14.1856.
    [35] AKAMATSU N, SUGAWARA Y, HASHIMOTO D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: A systematic review of the incidence, risk factors and outcome[J]. Transpl Int, 2011, 24(4): 379-392. DOI: 10.1111/j.1432-2277.2010.01202.x.
    [36] QIN YY, ZHOU D, WANG JD, et al. Management of biliary anastomotic stricture after liver transplantation: Experience from the University of Pittsburgh Transplant Institute[J]. Organ Transplantion, 2015, 6(6): 370-373. DOI: 10.3969/j.issn.1674-7445.2015.06.004.

    秦一雨, 周迪, 王健东, 等. 肝移植术后胆道吻合口狭窄处理方法探讨--来自美国匹兹堡大学移植研究所的经验[J]. 器官移植, 2015, 6(6): 370-373. DOI: 10.3969/j.issn.1674-7445.2015.06.004.
    [37] ZENG X, YANG X, YANG P, et al. Individualized biliary reconstruction techniques in autotransplantation for end-stage hepatic alveolar echinococcosis[J]. HPB (Oxford), 2020, 22(4): 578-587. DOI: 10.1016/j.hpb.2019.08.003.
    [38] CAI YS, LIU XW, XIAO H, et al. Biliary complications after liver transplantation: Diagnosis and treatments[J/CD]. Chin J Hepat Surg(Electronic Edition), 2018, 7(5): 391-395. DOI: 10.3877/cma.j.issn.2095-3232.2018.05.011.

    蔡云石, 刘雄威, 肖衡, 等. 肝移植术后胆道并发症的诊治[J/CD]. 中华肝脏外科手术学电子杂志, 2018, 7(5): 391-395. DOI: 10.3877/cma.j.issn.2095-3232.2018.05.011.
    [39] GUILLAUD A, PERY C, CAMPILLO B, et al. Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections[J]. HPB (Oxford), 2013, 15(3): 224-229. DOI: 10.1111/j.1477-2574.2012.00580.x.
    [40] XIAO LN, LI X, GENG C, et al. Safety and effectiveness of endoscopic treatment for biliary tract complications after liver transplantation[J]. Chin J Bases and Clin Gen Surg, 2020, 27(1): 53-57. DOI: 10.7507/1007-9424.201909051.

    肖丽娜, 李骁, 耿冲, 等. 内镜治疗肝移植术后胆道并发症的疗效[J]. 中国普外基础与临床杂志, 2020, 27(1): 53-57. DOI: 10.7507/1007-9424.201909051.
    [41] KIM SI. Bacterial infection after liver transplantation[J]. World J Gastroenterol, 2014, 20(20): 6211-6220. DOI: 10.3748/wjg.v20.i20.6211.
    [42] LI H, JIA YN, HE Q, et al. Progress of immunosuppressant management, infection prevention and treatment after liver transplantation in severe liver disease[J]. Ogran Transplantation, 2020, 11(3): 344-349. DOI: 10.3969/j.issn.1674-7445.2020.03.004.

    李瀚, 贾亚男, 贺强, 等. 危重症肝病肝移植术后免疫抑制剂管理和感染的防治进展[J]. 器官移植, 2020, 11(3): 344-349. DOI: 10.3969/j.issn.1674-7445.2020.03.004.
    [43] WANG ZX, QIN LX. Prevention and treatment of complications after liver transplantation[J]. Chin J Bases and Clin Gen Surg, 2018, 25 (9): 1025-1030. DOI: 10.7507/1007-9424.201808051.

    王正昕, 钦伦秀. 肝移植术后并发症的防治现状及进展[J]. 中国普外基础与临床杂志, 2018, 25(9): 1025-1030. DOI: 10.7507/1007-9424.201808051.
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