肝移植术后胆管狭窄介入治疗的疗效评价  

Interventional therapy for biliary stricture after orthotopic liver transplantation

作　　者：汪根树[1] 陆敏强[1] 杨扬[1] 蔡常洁[1] 李华[1] 郑丰平[2] 王卫东[3] 姜在波[4] 易慧敏[1] 易述红[1] 许赤[1] 许长谋[4] 何可可[4] 陈规划[1] 

机构地区：[1]中山大学器官移植研究所中山大学附属第三医院肝脏移植中心,广州510630 [2]中山大学器官移植研究所中山大学附属第三医院消化科,广州510630 [3]广东省人民医院肝胆外科 [4]中山大学器官移植研究所中山大学附属第三医院介入科,广州510630

出　　处：《中华普通外科杂志》2006年第8期570-572,共3页Chinese Journal of General Surgery

基　　金：中国科技部973计划子项目(2003CB515507);广东省自然科学基金项目(05300722)

摘　　要：目的评价原位肝移植(OLT)术后胆管狭窄(BS)介入治疗的疗效。方法回顾分析2003年10月至2006年1月本中心53例OLT术后BS介入治疗的疗效。53例BS患者共接受经十二指肠镜逆行胆管造影(ERC)介入治疗107次,包括鼻胆管引流术68次、球囊扩张及胆管内支架术26次和胆管造影术13次。其中9例患者接受经皮肝穿刺胆管造影(PTC)介入治疗11次,包括PTC 2次、PTCD 7次、球囊扩张术3次及胆管内支架术1次。1例行经“T”管置管引流术。结果ERC手术成功率为88．8％(95／107),鼻胆管引流术成功率为94％(6;4／68),胆管内支架术的成功率为88．5％(23／26)。PTC手术成功率为81．8％(9／11),PTCD成功率为100％(7／7),胆管支架术成功率为100％(1／1)。53例BS的介入治疗治愈率为28．3％(15／53),好转率为41．5％(22／53)。吻合口型、肝外型、肝内型、肝门型及弥漫型BS介入治疗的治愈率分别为66．7(4／6)、66．7％(10／15)、50％(1／2)、0(0／7)及0(0／22)。结论目前OLT术后BS介入治疗的疗效尚不理想。介入治疗的疗效与BS类型密切相关,吻合口狭窄、肝外型和肝内单发型BS的疗效较好,肝门型和弥漫型BS的疗效较差。Objective To evaluate interventional therapy for biliary stricture（BS） after orthotopic liver transplantation（OLT）, Methods The efficacy of interventional therapy for BS after OLT from Oct 2003 to Jan 2006 was analyzed retrospectively. Fifty-three patients received 107 times of interventional therapy through endoscopic retrograde cholangiography （ERC） which included 68 nasobiliary catheter placements ,26 biliary balloon dilatations and stent placements and 13 ERC. Nine patients received 11 times of interventional therapy through percutaneous transhepatic cholangiography （ PTC ） including 2 PTC, 7 percutaneous drainages ,3 biliary balloon dilatations and 1 biliary stent replacement. One patient received bile drainage through T tube. Results The success rate of ERC was 88.8% （95/107 ）, that of nasobiliary catheter placement 94% （64/68） , biliary stent placement 88.5% （23/26）. The success rate of PTC was 81.8% （9/11）, that of percutaneous drainage was 100% （7/7） , biliary stent replacement 100% （ 1/1 ）. The curative rate of interventional therapy for 53 patients with BS was 28.3% （ 15/53 ） , the improvement rate was 41.5% （ 22/53 ）. The curative rate of interventional therapy for anastomotic, extrahepatic, intrahepatic hilar and diffuse BS was respectively 66. 7% （ 4/6 ） ,66. 7% （ 10/15 ） ,50% （ 1/2 ） ,0 （ 0/7 ） and 0 （ 0/22 ）. Conclusions The efficacy of interventional therapy for BS after OLT was not satisfactory. The result relates to the type of BS, for anastomotic, extrahepatic and solitary intrahepatic BS this therapy was effective, while that for hilar and diffuse BS the prognosis was poor.

关 键 词：肝移植 手术后并发症 胆管狭窄 介入治疗 

分 类 号：R657.3[医药卫生—外科学]