目的:探讨肝移植术后胆道并发症的发生类型、危险因素及分类治疗的策略及效果。方法:回顾性分析2015年1月至2018年12月复旦大学附属华山医院545例次成人全肝肝移植受者术后胆道并发症的发生率、类型及病因分析，采取四分类治疗策略(保守治疗、微创手术、开腹手术、再次肝移植)，进一步分析治疗效果。结果:545例次全肝肝移植术后共发生胆道并发症48例(8.8%)。其中胆漏9例(占18.8%，3例为吻合口胆漏，6例为拔T管后胆漏)；单纯胆管吻合口狭窄14例(29.2%)；吻合口狭窄合并胆总管结石2例(4.17%)；单纯胆总管结石1例(2.1%)；缺血性胆管损伤(表现为非吻合口的多发肝内外胆管狭窄及反复胆管炎，1例表现为肝右叶多发胆汁瘤合并肝脓肿)19例(39.6%)；排斥反应后胆道损伤3例(6.3%)。统计分析显示供肝冷缺血时间延长(>11 h)是唯一有统计学意义的危险因素(n P11 h)，ERCP为主的微创治疗在肝移植术后胆道并发症的治疗中发挥了重要作用。随着外科技术的进步，缺血性胆道损伤成为胆道并发症的常见类型，且治疗困难，严重者唯一有效的治疗措施为再次肝移植。“,”Objective:To explore the incidence and risk factors of biliary complications after liver transplantation from organ donation by citizens after death and evaluate the strategy and efficacy of classified treatment.Methods:Between January 2015 and December 2018, the incidence, types and risk factors of biliary complications were analyzed retrospectively for 545 recipients of whole liver transplantation. According to different types and degrees, conservative measures, mini-invasive surgery, open surgery & liver retransplantation were adopted and treatment outcomes further analyzed.Results:Among 48 cases (8.8%) of biliary complications, there were bile leakage (n n=9, 18.8%), anastomotic stricture (n n=14, 29.2%), anastomotic stricture plus common bile duct stone (n n=2, 4.2%), common bile duct stone (n n=1, 2.1%), ischemic-type biliary lesion (n n=19, 39.6%) and biliary injury after rejection (n n=3, 6.3%). Statistical analysis revealed that cold ischemic time ≥11h was a significant risk factor for biliary complications. Based upon the type and severity of biliary complications, comprehensive therapeutic strategies of conservative measures, endoscopic retrograde cholangiopancreatography (ERCP), open surgery and liver retransplantation were adopted. ERCP yielded a curative rate of 78.6%(11/14) and 77.8%(7/9) for anastomotic stricture and bile leakage respectively. However, its efficacy for ischemic biliary stricture was not satisfactory with a relief rate of 42.1%(8/19). Four cases of severe ischemic biliary injury underwent liver retransplantation and discharged uneventfully.n Conclusions:The primary risk factor of biliary complications after liver transplantation is long cold ischemic time (≥11h). And ERCP-based procedure is vital for managing biliary complications. With the rapid advances of surgical technology, ischemic biliary injury has become the most common type. Due to its refractory nature, only liver retransplantation is efficacious for severe cases.