摘要
目的对原位肝移植术后胆管并发症患者的类型进行了回顾性总结,评价经内镜下逆行胰胆管造影(ERCP)疗效及安全性。方法原位肝移植术后出现胆管并发症的11例患者共行ERCP57次。治疗方法包括十二指肠乳头括约肌切开(EST)、胆管支架置入、气囊或探条扩张、及鼻胆管引流(ENBD)等。结果肝移植术后胆管并发症主要包括胆漏、胆管狭窄、胆泥和结石形成等,分别通过十二指肠乳头肌切开取石术、胆管狭窄扩张术及鼻胆管引流术等进行治疗。11例患者均行了胆管造影,其中9例(82%)显示吻合口狭窄,5例(45%)有胆泥形成,4例(36%)兼有吻合口狭窄及胆泥形成,1例(9%)为肝内胆管广泛狭窄,1例(9%)为肝内胆管稀疏及广泛狭窄伴胆泥形成。5/9例(56%)胆总管吻合口狭窄的患者通过扩张及支架置入得到了有效的治疗。4/5例(80%)胆泥形成患者通过胆管扩张、支架置入及鼻胆管引流等得以治愈。ERCP术后没有严重的相关并发症发生。结论肝移植术后胆管并发症主要为吻合口狭窄及胆泥形成,乳头切开取石及支架置入对于这些是有效且安全的治疗方法;而对于肝内胆管广泛狭窄及胆管稀疏的患者ERCP治疗效果不佳,再次肝移植可能是唯一选择。
【Objective】To assess the efficacy and safety of endoscopic retrograde cholangio-pancreatography（ERCP） in patients who underwent orthotopic liver transplantation（OLT）.【Methods】Fifty-seven endoscopic retro-grade cholangio-pancreatogrraphies（ERCPs） were performed in 11 patients with bile duct complication after OLT.The therapeutic maneuvers included endoscopic sphincterotomy（EST）,biliary stent placement,balloon or catheter dilation,irrigation and nasobiliary tube placement.The types of biliary complications after OLT were reviewed and the success of ERCP and therapeutic maneuvers were evaluated.【Results】Biliary complications after OLT including biliary leaking,biliary stricture and sludge and stone formation were treated respectively by endoscopic sphincterotomy（EST） with sludge extraction,stricture dilation or biliary drainage.Cholangiograms performed in 11 patients displayed anastomotic strictures in 9 patients（82%）,sludge in 5（45%）,both sludge and anastomotic stricture in 4（36%）,proximal common bile duct stricture in 1（9%） and both proximal common bile duct stricture and rarity with sludge formation in 1（9%）.Anastomotic stricture dilation was achieved effectively in 6/9 patients（67%） by dilation and stent placement,while sludge extraction was successfully treated in 4/5（80%） patients by dilation,stent placement or endoscopic nosobiliary drainage.No severe ERCP-related complications were observed and there was no mortality in these cases.【Conclusions】Most cases of biliary complication after liver transplantation are anastomotic stricture and sludge formation.Endoscopic sphincterotomy and stent placement seems to be the best and durable treatment for the patients.But endoscopy-based treatment can not deliver effective therapeutic effects for patients with intra-hepatic stricture and rarity and retransplantation might be the only choice for these patients.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第3期289-293,共5页
China Journal of Endoscopy
关键词
原位肝移植
胆管并发症
经内镜逆行胰胆管造影
orthotopic liver transplantation
biliary complications
endoscopic retrograde cholangiopancre-atography
