原位肝移植术后胆道充盈缺损性胆系并发症的研究  

Pathogenesis study of biliary filling defect related complications following orthotopic liver transplantation

作　　者：何宇[1] 张雷达[1] 卢倩[1] 丁钧[1] 杨占宇[1] 李智华[1] 别平[1] 王曙光[1] 董家鸿[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院,重庆400038

出　　处：《中华消化外科杂志》2007年第2期92-95,共4页Chinese Journal of Digestive Surgery

基　　金：全军“十五”重点课题资助项目（012077）;重庆市自然科学基金资助项目（CSPCBBS072）

摘　　要：目的探讨原位肝移植术后胆道充盈缺损性胆系并发症的病因及处理。方法回顾性分析1999年2月至2005年12月完成的325例原位肝移植的临床资料。结果术后发生胆泥3例，胆总管结石10例，胆管铸型综合征6例。MRCP或ERCP诊断准确率为100％，B超诊断准确率为78．9％。11例通过内镜介入取出结石、胆泥或铸型物，手术取石4例，再次肝移植手术4例。结论肝移植术后发生胆道充盈缺损性胆系并发症可能与缺血-灌注损伤、胆道缺血、排斥反应和CMV感染等因素有关。胆道成像技术有助于诊断及鉴别诊断。内镜治疗是首选方法，手术应在介入治疗无效后考虑。Objective To discuss pathogenesis and management of biliary filling defect related complications following orthotopic liver transplantation （OLT）, Methods Clinical date of 325 cases treated with OLT from February 1999 to December 2005 in our department were retrospectively analysed. Results There were 3 cases with sludge, 10 with biliary stone and 6 with biliary cast syndrome, with accuracy rate of diagnosis of MRCP/ ERCP for 100% and that of ultrasound for 76.9%. Stone, sludge or cast in 11 cases were removed from bile duct by ERCP. The stone in 4 cases were removed by operation; while 4 cases received retransplantation of the liver. Conclusions The formation of biliary stone, sludge and biliary cast syndrome after OLT is mainly due to ischemic reperfusion injury, bile duct ischemia, postoperative rejection and CMV infection. Cholangiography technique is helpful for diagnosis and differential diagnosis of these biliary complications after OLT. With regard to treatment, endoscopic intervention is the first alternative and operation follows unsuccessful intervention.

关 键 词：肝移植 胆道并发症 充盈缺损征 胆管结石 胆泥 胆管铸型综合征 

分 类 号：R686[医药卫生—骨科学]