Objective:To investigate the influencing factors for anastomotic biliary stric-ture after liver transplantation.Methods:The retrospective case-control study was conducted. The clinical data of 428 recipients who underwent allogeneic orthotopic liver transplantation in the First Hospital of Jilin University from September 2014 to August 2021 were collected. There were 324 males and 104 females, aged (52±10)years. Observation indicators: (1) surgical conditions of recipients; (2) occurrence of anastomotic biliary stricture after liver transplantation and its treat-ment; (3) analysis of influencing factors for anastomotic biliary stricture after liver transplantation. Follow-up was conducted using outpatient examination to detect occurrence of anastomotic biliary stricture and treatment up to August 30, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were represented as absolute numbers, and the chi-square test was used for comparison between groups. Logistic regression model was used for multivariate analysis. Results:(1) Surgical conditions of recipients: the operation time of 428 recipients was 465(420,520)minutes, the cold ischemia time was 368(320,450)minutes, and the volume of intraoperative blood loss was 2 500(1 500,4 000)mL. Of the 428 recipients, 142 cases were performed continuous biliary posterior wall anastomosis + interrup-ted anterior wall anastomosis by polygluconate sutures, 286 cases were anastomosed with polypro-pylene sutures, including 169 cases undergoing continuous biliary posterior wall anastomosis combined with interrupted anterior wall anastomosis, 73 cases undergoing completely interrupted biliary anterior and posterior wall anastomosis, and 44 cases undergoing completely continuous biliary anterior and posterior wall anastomosis. None of the 428 recipients had indwelling T tubes. (2) Occurrence of anastomotic biliary stricture after liver transplantation and its treatment:all the 428 recipients were followed up for 3 to 72 months, with a median follow-up time of 28 months. During the follow-up, 50 patients developed anastomotic biliary stricture, of which 41 patients were treated with endoscopic retrograde cholangiopancreatography, 8 patients were treated with percutaneous transhepatic cholangial drainage, and 1 patient was treated with surgery, showing no recurrence. (3)Analysis of influencing factors for anastomotic biliary stricture after liver transplanta-tion: results of univariate analysis showed that anastomosis method and donor liver cold ischemia time were related factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( χ2=15.74, Z=-2.04, P<0.05). Results of multivariate analysis showed that completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( odds ratio=0.25, 1.00, 95% confidence interval as 0.08-0.85, 1.00-1.01, P<0.05). Conclusions:Suture type is not an influencing factor for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation. Completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors.

肝门胆管癌(hilar cholangiocarcinomas,HC)指胆囊管开口以上的肝总管和其分义部以上左右肝管的胆管癌.它是一种罕见的恶性肿瘤,未接受治疗的中位生存期为12～24个月[1].由于其紧邻肝门区门静脉、肝动脉,容易导致局部血管侵犯,且易发生淋巴结转移及沿肝管向肝内侵犯[2],故外科手术切除率极低.HC早期通常没有典型的临床症状,一旦出现黄疸,往往大多数患者已经丧失了手术根治的机会.以往这些患者只能选择经皮肝穿刺胆道引流术等姑息性治疗手段,但Bismuth等[3]提出对没有肝外转移的此类患者可以考虑行原位肝移植手术(针对HC的肝移植包括离体肝切除+自体肝移植及原位肝移植,由于前者开展的中心少、完成例数少,所以本文中的肝移植均指的是原位肝移植).理论上原位肝移植是一种理想的治疗手段,因为病肝切除移除了肝门区肿瘤,受累的血管和胆道也可以通过供肝的植入而得到解决,理论上达到了R0切除,但由于移植术后胆管癌容易复发等因素,早期临床预后并不理想,故一度作为肝移植的禁忌证[4-6].但近年来,通过严格的术前评估和新辅助治疗,HC肝移植治疗通常能获得较好的预后,本文就此进行综述.

全国高等医学院校大学生临床技能竞赛的目的是推动医学教育改革.通过打造一支高质量的培训教师团队,精研培训内容,挖掘技能背后理论知识的运用和拓展,采用多种教学模式,发挥移动教学平台优势,以提高技能训练效率.同时在教学过程中系统化实施、个体化教学,实现"教"与"学"的共同进步,并要重视临床实践中的医学人文教学,提高医学生的临床综合思维能力,实现培养卓越医师的目标.

1病例资料患者女性,64岁,因"体检发现肝占位1周"于2016年9月18日入本院。患者无明显症状,于1周前体检腹部彩超提示肝脏肿瘤,为求进一步诊治入本院。查体:上腹部深压痛。颈部、腹股沟等体表浅淋巴结未触及明显增大。实验室检查:肝功能、生化、血常规、尿常规、血尿淀粉酶、血脂未见明显异常。HBV血清学标志

1病例资料男性,70岁,因目黄、尿黄3天入院。既往体健,入院查体无阳性体征。肝胆增强多排螺旋CT检查提示:肝内胆管略扩张,走行至肝门区管壁增厚、管腔狭窄,显示不清,局部见不规则软组织密度影,大小约2.0*2.4cm,不均匀明显强化,累及左右肝管、肝总管、胆总管起始处,病灶局部似突向腔外。肿瘤标志物糖类抗原（CA）72-4 10.48U/ml、CA12-539.93U/ml。术前诊断:肝门部胆管癌,随后行手术治疗。

目的 探讨心脏死亡器官捐献(DCD)边缘供肝应用的可行性.方法 回顾性分析吉林大学白求恩第一医院肝移植中心2015年4月至5月施行的3例边缘供肝肝移植供、受者临床资料.结果 3例边缘供肝供者均为男性,包括61岁老年供者供肝1例,重度脂肪变性(肝细胞气球样脂肪变＞65％)供肝1例,冷缺血时间延长(15.7 h)1例.均实施中国三类标准器官捐献.老年供肝肝移植受者术后肝功能恢复良好,未出现排斥反应.重度脂肪变性供肝肝移植受者术后肝功恢复差,术后1周因移植肝原发性无功能再次行肝移植.冷缺血时间延长供肝肝移植受者术后恢复顺利,术后10 d发生轻度急性排斥反应,将他克莫司由2.0 mg(2次/d)调整为2.5 mg(2次/d),肝功能恢复良好.结论 在综合评估供肝状况及合理匹配受者的前提下,边缘供肝能够安全使用,并能取得良好的临床效果.老年供肝可以匹配终末期肝病模型评分低的老年受者;冷缺血时间延长供肝可通过增加灌注次数以适当缓解术后肝功能恢复延迟情况;重度脂肪变性供肝仍应谨慎使用,要综合其他影响供肝的因素及受者状况来决定.