摘要
目的探讨全覆膜自膨式金属支架（FCSEMS）在肝移植术后胆道吻合口狭窄中的应用价值及其安全性和有效性。方法回顾性分析2011年1月至2014年6月36例肝移植术后发生胆道吻合口狭窄受者接受经内镜逆行性胰胆管造影术（ERCP）下放置FCSEMS治疗的临床资料。内镜下择期拔除支架，分析支架放置时间和更换频率，对受者的随访至少为取出FCSEMS后6个月，观察治疗效果及早期并发症的发生情况。结果36例受者共使用了92个FCSEMS，每例受者平均使用2．56个，其中20例（55．56％）放置了3个FCSEMS，16例（44．44％）放置了2个FCSEMS。FCSEMS支架应用时间持续（12．62±3．21）个月（8～15．5个月）。FCSEMS均顺利取出，无移位或脱出情况。36例受者中，1例在随访第8个月时出现胆道狭窄复发，此受者正接受再次FCSEMS治疗过程中。另35例胆道吻合口狭窄得到明显改善，治疗有效率为97．2％（35／36），胆道狭窄总体复发率为2．78％（1／36）。肝功能检测表明，在取出FCSEMS后6个月受者的丙氨酸转氨酶和胆红素总量水平分别为（85±52）U／L和（17．1±5．1）μmol／L，显著低于放置FCSEMS前的（148±107）U／L和（34．2±20．5）μmol／L，差异均有统计学意义（P〈0．05）。36例受者在FCSEMS置入后近期，出现发热1例，上腹胀痛4例，以及胰腺炎3例，并发症发生率为22．22％，经过抗炎、止痛、抑制胰酶等常规对症处理后均缓解。结论FCSEMS治疗肝移植术后胆道吻合口狭窄是一种安全、有效的方法。
Objective To explore the safety, efficacy and value of fully-covered self-expandable metallic sent （FCSEMS） for treatment of biliary strictures after liver transplantation. Method The clinical data of 36 patients undergoing endoscopic retrograde cholangiopancreatography （ERCP） for biliary strictures after liver transplantation from January 2011 to June 2014 were retrospectively analyzed. The FCSEMS was removed under an endoscope. The therapeutic efficacy, sent duration, sent removing rate and early-term complication were analyzed. Result 92 FCSEMSs were placed in 36 patients with the mean number of 2. 56. The sent duration time was 8-15. 5 months with a mean time of 12. 62 ± 3. 21 months. The effective rate was 97. 22% （35/36） and only 1 patient showed biliary strictures recurrence. The TBIL and ALT levels after FCSEMS removal were significantly reduced. The early-term complication rate associated with FCSEMS was 22. 22%, including fever （ 1 case）, abdominal distention （4 cases）, mild pancreatitis （3 cases）. All FCSEMSs were successfully retrieved, not translocated and slipped. Conclusion FCSEMS is a safe and effective treatment method for biliary strictures after liver transplantation,
出处
《中华器官移植杂志》
CAS
CSCD
2015年第4期201-204,共4页
Chinese Journal of Organ Transplantation
基金
国家高技术研究发展计划（2012AA021001）
天津市科技计划（重点）项目（14ZCZDSY00019）
关键词
内镜治疗
全覆膜自膨式金属支架
肝移植
胆道吻合口狭窄
Endoscopy
fully-covered self-expandable metallic sent
liver transplantation
biliary anastomotic stricture
