内镜逆行胰胆管造影在肝移植后胆系并发症诊断和治疗中的作用  

The role of endoscopic retrograde cholangiopancreatophy in the diagnosis and therapy of biliary complications after orthotopic liver transplantation

作　　者：赵秋[1] 陈知水[2] 覃华[1] 李荣香[1] 曾凡军[2] 刘南植[1] 王天才[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院消化内科,武汉430030 [2]华中科技大学同济医学院器官移植研究所

出　　处：《中华器官移植杂志》2004年第5期291-293,共3页Chinese Journal of Organ Transplantation

摘　　要：目的评价内镜逆行胰胆管造影(ERCP)在肝移植术后胆系并发症诊治中的临床价值。方法11例肝移植术后并发胆系并发症,其中吻合口狭窄4例,吻合口及供肝肝总管均狭窄2例,胆漏2例,多发性硬化性胆管炎样狭窄2例,移植肝胆总管与受者胆总管分离1例,分别行ERCP检查及治疗。结果4例吻合口狭窄者,放置胆管塑料支架,2例吻合口和供肝肝总管均狭窄者放置Wallstent金属支架,上述6例近期黄疸均消退;2例胆漏者中,1例放置胆道塑料内支架,另1例行乳头括约肌切开术,均于2周内胆漏愈合;2例移植肝多发性硬化性胆管炎样狭窄者,1例行乳头括约肌切开后取出少量坏死胆管上皮样组织,另1例未行内镜治疗;1例移植肝胆总管与受者胆总管分离者再次手术行胆管吻合术。结论内镜逆行胰胆管造影可用于肝移植术后的常见胆系并发症的诊断与治疗,可获得较好的近期疗效。Objective To Evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatophy (ERCP) on patients with biliary complications after orthotopic liver transplantation. Methods Eleven cases of othotopic liver transplantation with obstructive jaundice or bile leak were diagnosed and treated with ERCP. Results Among 11 cases, there were 4 cases of choledocholedochostomy anastomosis stricture, 2 cases of choledocholedochostomy anastomosis and honor hepatic common bile duct stricture, 2 cases of bile leak, 2 cases of sclerosing cholangitis, and one case of abruption of choledocholedochostomy anastomosis after orthotopic liver transplantation with jaundice. Four patients with choledo choledochostomy anastomosis stricture were treated by plastic stent, and two cases of choledocholedochostomy anastomosis and honor hepatic common bile duct stricture by metallic stent. Jaundice of the 6 cases subsided to normal in 2 to 4 weeks. In two patients with bile leak, one was treated by endoscopic plastic stent and another by sphincterotomy, and they were cured in 2 weaks. Conclusion In the patients suspected of biliary tract complications after orthotopic liver transplantation, ERCP can identify biliary abnormalities if present and offer multiple therapeutic options. Endoscopic therapy is usually successful in patients with anastomosis or hepatic common bile duct stricture and bile leak.

关 键 词：并发症 内镜逆行胰胆管造影 狭窄 移植肝 肝移植术 胆漏 术后 受者 结论 目的 

分 类 号：R657.3[医药卫生—外科学]