肝脏移植、心脏移植及肾脏移植等已广泛开展，大批受者长期存活。本文现就这组特殊人群在移植术后患胆道结石病的机理及其处理原则介绍如下。
1器官移植受体胆石病的发生机理
肝移植术后胆管结石与胆泥形成并引起胆道梗阻可随时发生。除了明确的结石外，胆泥形成胆管铸形并广泛分布于肝内胆管也有报道。胆管粘膜损害、胆管梗阻、移植肝的冷、热缺血、感染及胆固醇过饱和等都在胆管结石形成过程中发挥作用，但胆管梗阻可能是肝移植术后胆管结石形成的最重要因素［1］。胆管结石和胆泥形成的患者，绝大多数都伴有胆管狭窄，这个狭窄可以发生在胆管胆管吻合口和胆管空肠吻合口，也可发生在非吻合口处的胆管。胆管内异物如T型管或内支撑管也可作为结石形成的核心。除了这些引起胆汁淤积的物理学原因外，环孢素A（CsA）在胆石发生中也起了作用［2］： 它可抑制胆汁分泌，促进胆汁淤积，而FK506（普乐可复）似乎没有这方面的副作用。此外，肝移植受者胆汁中胆固醇呈过饱和状态，且T管引流及胆酸池的减少还加重这种状态。目前还不清楚胆道重建方式对胆道结石形成有没有影响。但从理论上讲，胆肠吻合会增加肠源性细菌进入胆道的机会，从而导致胆红素去结合化，并进一步形成色素石。但到底是胆管对端吻合还是胆肠吻合后更易形成结石，目前尚无详尽研究。
Citation：
文天夫,魏永刚,黄建文. Cholelithiasis in Organ Transplantation Receipts. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(4): 405-406. doi:
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- 1. Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation [J]. Dig Dis, 1999; 17(3)∶133.
- 2. Vessey DA, Kelley M. Related Articles. Inhibition of bile acid conjugation by cyclosporin A [J]. Biochim Biophys Acta， 1995; 1272(1)∶49.
- 3. Cao S, Cox K, So SS, Berquist W, et al. Potential effect of cyclosporin A in formation of cholesterol gallstones in pediatric liver transplant recipients [J]. Dig Dis Sci， 1997; 42(7)∶1409.
- 4. Ito T, Kimura T, Yamaguchi H, et al. Acute pancreatitis induced by cyclosporin A under stimulation of pancreas by caerulein [J]. Pancreas, 1993; 8(6)∶693.
- 5. Ganschow R. Cholelithiasis in pediatric organ transplantation: detection and management [J]. Pediatr Transplant, 2002; 6(2)∶91.
- 6. Schwartz DA, Petersen BT, Poterucha JJ, et al. Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation [J]. Gastrointest Endosc, 2000; 51(2)∶169.
- 7. Richardson WS, Surowiec WJ, Carter KM, et al. Gallstone disease in heart transplant recipients [J]. Ann Surg, 2003; 237(2)∶273.
- 8. Graham SM,Flowers JL,Schweitzer E,et al. The utility of prophylactic laparoscopic cholecystectomy in transplant candidates [J]. Am J Surg, 1995; 169(1)∶44.
- 9. Melvin WS, Meier DJ, Elkhammas EA, et al. Prophylactic cholecystectomy is not indicated following renal transplantation [J]. Am J Surg, 1998; 175(4)∶317.
