摘要
目的探讨肝移植术后胆道非吻合口狭窄(NABS)的再手术时机及术式选择。方法回顾性分析2003年8月-2014年4月10年间我中心14例NABS患者的临床资料。根据胆道造影结果,将NABS分为围肝门部狭窄(Ⅰ型)、肝门部+肝内胆管狭窄(Ⅱ型)和肝内胆管多发狭窄(Ⅲ型)3型,分别制定不同的再手术方案,随访了解再手术疗效。结果 NABS总体发生率为3.3%(14/421),与非NABS患者比较,其胆红素和胆道酶谱明显升高(P<0.01)。14例NABS患者中Ⅰ型4例,Ⅱ型8例,Ⅲ型2例。NABS首选介入微创治疗,有效率为57.1%(8/14)。6例(1例Ⅰ型、4例Ⅱ型、1例Ⅲ型)无效者转再手术治疗。1例Ⅰ型患者行肝门部胆管整形-胆肠吻合术,余5例Ⅱ型及Ⅲ型患者接受再次移植。5例再移植患者术中出血2570±851ml,手术时间492±173min,与首次移植相比差异无统计学意义(P>0.05),术后真菌感染死亡1例。4例伴肝动脉狭窄闭塞的NABS患者中3例接受了再次移植,再移植率达75%(3/4)。5例患者术后随访胆管炎症状消失,总胆红素均值从123.4μmol/L降至31.6μmol/L,达临床治愈标准。结论对内镜介入治疗无效的NABS患者,尤其是合并肝动脉狭窄者,应及时转再手术治疗。术式的选择应参考胆道狭窄范围的分型,肝门部胆管整形-胆肠吻合术及再次移植均是疗效确切的术式。
Objective To investigate the re-operation timing and surgical modality for non-anastomotic biliary stricture （NABS） after orthotopic liver transplantation （OLT）. Methods The clinical data of 14 NABS patients hospitalized in our center from August 2003 to April 2014 were analyzed retrospectively. The patients were treated with different modalities of re-operation according to cholangiographic results, and the outcomes of re-operation were noted by postoperative follow-up. Results Among 421 OLT patients, NABS was seen in 14 （3.3%, 14/421）, and it was accompanied by stenosis of hepatic artery in 4. Their total bilirubin, ALP and r-GGT levels were significantly higher in NABS patients than in non-NABS patients （P〈0.01）. According to cholang/ographic findings, NABS was divided into 3 types： hepatic bile duct strictures （4 patients, type Ⅰ ）, multiple extrahepatic and intrahepatic biliary strictures （8 patients, type Ⅱ ）, intrahepatic biliary stricture （2 patients, type m）. The cure rate of interventional treatment in this study was 57.1% （8/14）, and 6 patients eventually required surgical treatment again. The type Ⅰ patient was treated with goux-en-Y anastomosis, and re-transplantation for other 5 patients （type Ⅱ in 4 and type Ⅲ in 1）. Among these 5 patients receiving liver re-transplantation, 1 patient died of perioperative fungal infection. The blood loss （2570± 851ml） and operation time （492 ± 173min） in those re-transplantation patients were almost the same as their previous-transplantation （P〉 0.05）. More than half of type Ⅱ and m patients needed re-transplantation, but the probability of re-transplantation was especially higher for those with hepatic artery stenosis （75%, 3/4）. Cholangitis disappeared and the total bilirubin significantly reduced from 123.4μmol/L to 31.6μmol/L after resurgery. Conclusions For those NABS patients who may fail to be improved after a minimally invasive treatment, especially when it was combined with hepatic
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2015年第8期643-646,共4页
Medical Journal of Chinese People's Liberation Army
基金
广东省科技计划项目(2012A030400023)~~
关键词
肝移植
胆道非吻合口狭窄
消化系统外科手术
liver transplantation
non-anastomotic biliary structure
digestive system surgical procedures
