摘要
目的探讨成人原位肝移植术后胆道并发症的内镜逆行胰胆管造影(ERCP)表现和内镜治疗方法,评估ERCP和内镜治疗的作用。提高肝移植的手术疗效和改善患者的生存质量,延缓二次肝移植时间。方法 20例成人原位肝移植术后胆道并发症患者实施32次ERCP,并根据ERCP结果实施相应治疗。结果 19例31次获得成功,ERCP成功率为96.88%(31/32)。全组病人ERCP后明确胆道并发症原因,并发症发生的部位为:供体肝、供体及受体胆管、胆管吻合口及十二指肠乳头。其中胆管炎性狭窄5例,胆管炎性狭窄伴肝内外胆管胆泥或胆石形成3例,胆管吻合口狭窄3例,十二指肠乳头功能紊乱2例,十二指肠乳头狭窄2例,胆管过长、扭曲2例,供体胆管与受体胆管直径差异过大1例,胆总管轻度扩张1例。本组无胆漏及胆道出血患者,胆管炎性狭窄发生率最高,为40%(8/20);其次为胆管吻合口狭窄,为15%(3/20)。内镜治疗治愈率为60%(12/20),好转率为35%(7/20)。治疗方式选择:乳头扩张12.50%(4/32),乳头括约肌切开37.50%(12/32),胆管扩张43.75%(14/32),鼻胆管引流68.75%(22/32),胆管支架引流28.12%(9/32),取石12.50%(4/32),胆管冲洗31.25%(10/32)。结论内镜治疗已成为成人原位肝移植术后胆道并发症非手术治疗的首选方式和主要方法。
Objective To explore endoscopic retrograde cholangiopancreatography（ERCP） images finding and endoscopic treatment of biliary complications after adult orthotopic liver transplantation（BCAOLT）,to assess the effectiveness of ERCP imaging diagnosis and endoscopic treatment.Improving liver transplant surgery curative effect and the quality of life in patients,delaying the re-transplantation time.Methods 20 cases of biliary complications after adult orthotopic liver transplantation with ERCP 32 times,and implement corresponding treatment according to the results of ERCP.Results 19 cases of 31 successful,ERCP success rate was 96.88%（31/32）.The reasons for biliary complications were definite after ERCP in all cases.The location of biliary complications occurred in part as follows： donor liver,donor and receptor bile duct,bile duct anastomotic stoma and duodenal papilla.5 cases of bile duct stricture with cholangitis;3 cases of extrahepatic and intrahepatic bile duct stricture with cholangitis,combined with biliary sludge formation or cholelithiasis;bile duct anastomotic stricture in 3 cases;duodenal papillary dysfunction in 2 cases;duodenal papillary stenosis in 2 cases;bile duct was too long and twisted in 2 cases;donor and receptor bile duct diameter was too large difference in 1 case;light simplex choledochectasia in 1 case.No hemobilia and bile leakage in patients.Bile duct stricture with cholangitis incidence rate was the highest in this group,40%（8/20）;followed by bile duct anastomotic stricture,15%（3/20）.Endoscopic cure rate was 60%（12/20）;improvement rate was 35%（7/20）.The choice of treatment： duodenal papilla expansion 12.50%（4/32）,endoscopic sphincterotomy（EST） 37.50%（12/32）,bile duct expansion 43.75%（14/32）,endoscopic nasobiliary drainage（ENBD） 68.75%（22/32）,endoscopic retrograde biliary drainage（ERBD） 28.12%（9/32）,extraction of bile duct stones 12.50%（4/32）,bile duct irrigation 31.25%（10/32）.Conclusion Endoscopic therapy has become main
出处
《肝胆外科杂志》
2010年第5期338-342,共5页
Journal of Hepatobiliary Surgery
关键词
原位肝移植术后
胆道并发症
内镜逆行胰胆管造影
内镜治疗
Orthotopic liver transplantation
Biliary complications
Endoscopic retrograde cholangiopancreatography（ERCP）
Endoscopic treatment
