Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults...Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients.展开更多
目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法...目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法为切开胆总管取净结石,鼻胆管引导器插入胆总管通过十二指肠乳头进入十二指肠,引导器开口指向幽门。内镜活检钳在鼻胆管引导器的导引下进入十二指肠并向上通过幽门到达胃腔,活检钳在胃腔内夹住术前置入的鼻胃管前端的尾状乳胶条,将鼻胃管导入十二指肠、十二指肠乳头进入胆总管,再由鼻胃管引导新型鼻胆管进入十二指肠,最后出外鼻孔。新型鼻胆管头端的环型乳胶弹力圈支撑于肝总管内,一期缝合胆总管。术后5～7 d 拔除鼻胆管。结果 34例术中置新型鼻胆管成功率100%,无一例发生胆漏,拔管时间(5.0±1.5)d、术后住院时间(9.2±1.3)d 较 T 管引流组(分别为15.2±3.6 d、17.1±5.6 d)短,差异有显著性(P<0.01)。结论术中置新型鼻胆管、胆总管一期缝合术适应证广、操作简单、安全可靠,彻底消除了 T 型管引流所致胆漏等并发症,缩短了住院天数,值得进一步推广。展开更多
文摘Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients.
文摘目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法为切开胆总管取净结石,鼻胆管引导器插入胆总管通过十二指肠乳头进入十二指肠,引导器开口指向幽门。内镜活检钳在鼻胆管引导器的导引下进入十二指肠并向上通过幽门到达胃腔,活检钳在胃腔内夹住术前置入的鼻胃管前端的尾状乳胶条,将鼻胃管导入十二指肠、十二指肠乳头进入胆总管,再由鼻胃管引导新型鼻胆管进入十二指肠,最后出外鼻孔。新型鼻胆管头端的环型乳胶弹力圈支撑于肝总管内,一期缝合胆总管。术后5～7 d 拔除鼻胆管。结果 34例术中置新型鼻胆管成功率100%,无一例发生胆漏,拔管时间(5.0±1.5)d、术后住院时间(9.2±1.3)d 较 T 管引流组(分别为15.2±3.6 d、17.1±5.6 d)短,差异有显著性(P<0.01)。结论术中置新型鼻胆管、胆总管一期缝合术适应证广、操作简单、安全可靠,彻底消除了 T 型管引流所致胆漏等并发症,缩短了住院天数,值得进一步推广。
