原位肝移植术后胆管狭窄的诊断和治疗  

Diagnosis and treatment of biliary stricture after orthotopic liver transplantation

作　　者：杨玉龙 陈海龙[2] 谭文翔 付维利 冯众一 王晓亮 郭宏伟 郎桂玲 王晓光 席力罡 毛卫 吕文才 

机构地区：[1]大连市肝胆外科研究所 友谊医院肝胆外科,116001 [2]大连医科大学附属第一医院

出　　处：《中华器官移植杂志》2007年第8期454-457,共4页Chinese Journal of Organ Transplantation

基　　金：大连市优秀青年科学基金(2004B3SF165)

摘　　要：目的探讨原位肝移植术后胆管狭窄的诊断和治疗方法。方法利用胆道内镜技术,对14例原位肝移植术后发生的胆管狭窄进行了诊断和分析;采取球囊扩张后支撑管支撑狭窄的方法进行治疗。结果经胆道造影和内镜综合诊断胆管吻合口狭窄13例(92.86%,其中1例是结石导致的狭窄假象);非吻合口狭窄1例(进行了2次肝移植)。通过胆道造影明确诊断的4例吻合口狭窄中,1例采取球囊扩张1次治愈,2例行经内镜十二指肠乳头括约肌切开术+网篮取石+鼻胆引流术后仍然发生胆系感染和黄疸而行手术以及纤维胆道镜治疗,1例2次肝移植术后发生急性排斥反应而死亡。通过T型管造影,1例发现条状负影,无狭窄,纤维胆道镜观察胆管吻合口愈合佳,黏膜移行良好;2例肝内显影差或不显影而呈胆管消失改变,纤维胆道镜取净结石后,扩张吻合口的狭窄后用支撑管分别支撑3、4个月时狭窄消失,黏膜移行良好,拔管治愈;8例肝内外胆管显影模糊,肝外和肝内Ⅰ、Ⅱ级胆管有条索状、柱状、树枝状负影和非吻合性狭窄征象,纤维胆道镜观察取净结石后观察吻合口处均有不同程度的狭窄、充血水肿,扩张支撑平均2.5个月后,镜下观察狭窄消失,黏膜移行佳;1例造影提示吻合口狭窄,经扩张后,内镜观察未发现结石,支撑2个月后拔管治愈。结论应用胆道内镜诊断胆管狭窄直观可靠。胆道狭窄扩张支撑后拔管的标准为:T型管造影通畅无狭窄,内镜观察狭窄环消失,吻合口处黏膜移行。通过内镜技术治疗胆管狭窄具有微创、安全、有效和方便等优点。Objective To investigate the diagnosis and treatment of biliary stricture after orthotopic liver transplantation. Methods Fourteen cases of biliary stricture after orthotopic liver transplantation were diagnosed and analyzed by T tube radiography and endoscopic technique. And by endoscopic technique, the stricture was supported with tube after balloon dilatation. Results Four cases of anastomosis stricture were identified by ERCP. One of these 4 cases was treated with balloon dilatation; Biliary infection and jaundice occurred in 2 cases after EST ＋ basket lithotripsy ＋ ENBD, and treated by operations or fibrocholedochoscopy; 1 case died of acute rejection after liver transplantation. By T tube radiography, 1 case was found having strip-like negative simulacrum or no stricture, wellhealed anastomosis and good mucous transition; 2 cases had poor or no intrahepatic visualization and subjected to anastomosis dilatation after the calculi removal by fibrocholedochoscope, and stricture disappeared in 3 or 4 months; In 8 cases there were blur extrahepatic or intrahepatic biliary visualization, cord-like, column or branch-like negative simulacrum in biliary ducts and sign of non-anastomosis stricture, and after removal of calculi, anastomosis stricture, congestion, edema were found and all these disappeared after average 2. 5 months of dilatation; the other 1 case was found having stricture by T radiography, but no calculi was found by fibrocholedochoscope, finally the T tube was removed after 2 months of stricture dilatation. Conclusions It is reliable to diagnose biliary stricture by endoscope in combination with T tube radiography. The standard of removing T tube after stricture dilation is： T tube radiography shows smooth biliary duct with no stricture, disappearance of stricture ring under an endoscope, good mucosal transition of anastomosis. Endoscopic technique is a minimally invasive, safe, effective and convenient method in the treatment of biliary stricture.

关 键 词：肝移植 手术后并发症 内镜检查 胆管狭窄 

分 类 号：R657.3[医药卫生—外科学]