经内镜逆行胆管造影在肝移植术后胆管并发症中的应用价值  

The practical value of endoscopic retrograde cholangiography in biliary complications after liver transplantation

作　　者：汪根树[1] 陆敏强[1] 杨扬[1] 蔡常洁[1] 郑丰平[2] 王卫东[3] 李华[1] 许赤[1] 易述红[1] 易慧敏[1] 陈规划[1] 

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

出　　处：《中华外科杂志》2006年第21期1453-1455,共3页Chinese Journal of Surgery

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

摘　　要：目的探讨经内镜逆行胆管造影在肝移植术后胆管并发症中的应用价值。方法回顾分析本中心2003年10月至2006年3月经内镜逆行胆管造影诊断及治疗的71例肝移植术后胆管并发症的资料。71例胆管并发症包括52例胆管狭窄、6例胆漏和13例胆管结石。结果经内镜逆行胆管造影诊断胆管狭窄、胆漏和胆管结石的成功率分别为98·1%(51/52)、100%和100%(13/13)。经内镜逆行胆管造影介入治疗胆管吻合口狭窄、肝外型、肝门型、肝内型和弥漫型胆管狭窄的治愈率分别均为66·7%、66·7%、0、0和0,治疗胆漏的治愈率为66·7%,治疗胆总管结石和肝内胆管结石的治愈率分别为77·8%和0。结论经内镜逆行胆管造影是肝移植术后胆管并发症的有效诊断方法。不同类型的胆管并发症经内镜逆行胆管造影介入治疗的疗效不同。经内镜逆行胆管造影介入治疗仅能治愈部分胆管并发症(如胆管吻合口狭窄、肝外型胆管狭窄、轻中度胆漏及胆总管结石)。Objective To investigate the practical value of endoscopic retrograde cholanglography （ERC） in biliary complications after liver transplantation. Methods The data of 71 biliary complications after liver transplantation were analyzed retrospectively. M1 patients were diagnosed and treated by ERC in our center from October 2003 to March 2006. The biliary complications included 52 cases of biliary stricture, 6 biliary leakage and 13 biliary stone. Results The diagnostic rate of ERC for biliary stricture, leakage and stone was 98. 1% （51/52） , 100% （6/6） and 100% （13/13） , respectively. The cure rate of interventional therapy through therapeutic ERC for anastomotic, extrahepatic, hilar, intrahepatic and disfnsed biliary stricture was 66. 7% （ 4/6 ）, 66. 7% （ 10/15 ）, 0 （ 0/7 ）, 0 （ 0/2 ） and 0 （ 0/21 ）, respectively. And that for biliary leakage, common bile duct and intrahepatic bile duct stone was 66. 7% （4/ 6）, 77.8% （7/9） and 0（0/4）, respectively. Conclusions ERC is effective for diagnosis of biliary complications after liver transplantation. The effect of interventional therapy through ERC varies with the type of biliary complications. Only part of biliary complications （anastomotic stricture, extrahepatic biliary stricture, gently and moderate biliary leakage, common bile duct stone） can be cured by interventional therapy through ERC.

关 键 词：肝移植 手术后并发症 胆管 胰胆管造影术 内窥镜逆行 

分 类 号：R657.3[医药卫生—外科学]