摘要
目的回顾性分析活体肝移植术后胆道并发症的临床特点,探讨内镜处置相关问题的有效方式。方法21例活体肝移植胆道并发症患者接受ERCP诊疗,根据胆道造影所见给予相应治疗,观察内镜治疗的效果。结果21例患者中43.8%处于术后早期,共接受28次内镜诊疗,其中发现胆管吻合口狭窄19例(90.4%),且多数存在成角畸形;发现吻合口胆漏9例(42.9%)。内镜治疗的操作成功率为85.7%,包括鼻胆管引流5例次、单支架引流10例次、气囊扩张和(或)多支架支撑9例次、胆漏腔引流2例次。随访中3例胆漏患者经治疗漏口已愈合,2例吻合口狭窄已基本消除。结论活体肝移植术后胆道并发症发生率高且发生早,吻合口严重狭窄伴成角畸形多见,合并胆漏的发生率较高;采用“先治漏,后治窄”的原则进行内镜治疗可取得满意的疗效。
Objective To retrospectively investigate the clinical features of the biliary tract compli- cations after living donor liver transplantation (LDLT) and the efficacy of endoscopy. Methods The LDLT patients with biliary complications were given endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic therapies were can'ied out according to the result of cholangiogram. Results Twenty-one patients, among whom 43.8% were at early postoperative stage, underwent 28 endoscopic procedures. Nineteen patients (90. 4% ) had biliary anastomotic strictures with angled malformation. Bile leakage was found in 9 patients (42.9%). The success rate of endoscopic therapy was 85.7% , including nose-bile drainage in 5, stent placement in 10, balloon dilatation and/or multiple stents placement in 9 and bile collection drainage in 2. During follow-up, leak heal was confirmed in 3 patients and stricture resolution was achieved in another 2 cases. Conclusion Bilial7 complication is relatively common in the early stage after LDLT, and severe anastomotic stricture with angled malformation is most frequently seen, usually associated with bile leakage. Series of endoscopic interventions with the strategy of "leak first, and then stricture" might achieve satisfactory outcome.
出处
《中华消化内镜杂志》
2008年第11期587-590,共4页
Chinese Journal of Digestive Endoscopy
关键词
肝移植
手术后并发症
胰胆管造影术
内镜逆行
胆漏
胆道狭窄
Liver transplantation
Postoperative complications
Cholangiopancreatography, endoscopic retrograde
Bile leakage
Biliary stricture