摘要
目的总结治疗肝移植术后胆道铸型综合征（BCS）的经验。方法回顾性分析103例肝移植术后BCS病人的治疗方法及转归。术后〈3个月病人出现较重梗阻症状或合并有胆道感染时，以PTBD外引流管置换T型管。术后≥3个月病人，行纤维胆道镜治疗。BC取出后，对有吻合口以上胆道上皮坏死者，以支撑管支撑3～6个月。病人按照病变程度分成单纯BC组、中度坏死（累及肝门部及以下胆道上皮）BC组、重度坏死（累及肝内外各级胆管）BC组，统计各组在治疗前后1周的肝功酶指标（GPT、GGT、ALP、TB、DB），用SPSS11．5软件行统计学分析。结果经过治疗后，单纯BC组32例，在随访过程中，未发现再有BC出现，各项肝功酶均在正常范围。中度坏死BC组53例，经支撑管支撑3～6个月后，治疗前后各项肝功指标有显著性差异（P〈0．05）。重度坏死BC组18例，9例因经济原因未能再次移植死于多脏器衰竭，1例死于急性梗阻性化脓性胆管炎。8例接受了再次肝移植。其中4例围手术期死于多脏器衰竭，3例行再次肝移植后恢复正常未再有BCS存在，1例出现再次肝移植后BCS，行三次肝移植未再发现BCS存在。结论BCS大多可通过纤维胆道镜取BC和后续的支撑管支撑治疗而解除梗阻症状，明显改善BCS病人的生活质量，降低BCS的再次移植率。BC合并肝内外胆管弥漫坏死者应尽早再次移植。
Objective To summarize the experience in treatment of biliary cast syndrome in patients after othotopic liver transplantation. Methods The therapeutic means and prognosis of 103 patients with biliary cast syndrome after orthotopie liver transplantation were retrospectively analyzed. Patients post operation time〈3m would undergone T tube replace with PTBD tube when obstruction of biliary tract became serious or accompanied infection in bile duct. Endoscopic therapy would perform for post operation time ≥3m patients. According to the injury level of biliary duct epithelium, patients were derided into three groups （mild,moderate and severe group）,and the supporting tube was set into the place where the necrosis present. GPT,GGT, ALP,TB.DB in serum were determined a week before treatment and a week after treatment in each group. Data were analyzed with software SPSSll. 5. Results There were 32 cases in mild group , no BC was found once more within the research period time and the biochemical indicators in serum were normal after therapy. In the moderate group,53 patients were found. After supporting right at the necrosis spot about 3-6m, the detected indicators were marked difference between twice test. There were 18 patients in the severe group. 9 died of MOSF, 1 died of A OSC, 8 had undergone retransplantation. In the retransplantation patients, 4 died of post operation MOSF,3 recovered to normal, 1 patient was found BCS once more 15 d post the retransplantation and the third-transplantation was perforrned 7m post the second transplantation, no was found again. Conclusions After endoscopic therapy and supporting in the necrosis spot, many BCS patients would get better in either symptom or biochemical indicator. BCS patients who found severe necrosis in biliary tract need retransplantation as early as possible.
出处
《中华肝胆外科杂志》
CAS
CSCD
2007年第3期174-178,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
肝移植
胆道疾病
铸型
内窥镜
放射
治疗
Liver transplantation
Biliary tract disease
Cast
Endoscopic
Radiology
Therapy
