治疗性内镜逆行胰胆管造影在成人原位肝移植术后胆道并发症的应用  

The application of therapeutic ERCP in biliary complications of adult orthotopic liver transplantation

作　　者：田虎[1] 冯秋实[2] 郭源[1] 滕木俭[1] 李志强[1] 

机构地区：[1]山东省千佛山医院普外中心肝胆外科,山东济南250014 [2]北京大学第一医院普外科,北京100034

出　　处：《中国内镜杂志》2010年第11期1156-1159,1163,共5页China Journal of Endoscopy

摘　　要：目的探讨成人原位肝移植术后胆道并发症的内镜逆行胰胆管造影(ERCP)表现和内镜治疗方法,评估治疗性ERCP的作用和地位。方法 22例成人原位肝移植术后胆道并发症患者实施34次ERCP,并根据ERCP结果实施相应内镜治疗。结果 21例33次获得成功,ERCP成功率为97.06%(33/34)。全组患者ERCP后明确胆道并发症原因,并发症发生的部位为:供体肝、供体及受体胆管、胆管吻合口及十二指肠乳头。其中胆管炎性狭窄5例,胆管炎性狭窄伴肝内外胆管胆泥或胆石形成3例,胆管吻合口狭窄3例,十二指肠乳头功能紊乱2例,十二指肠乳头狭窄2例,胆管过长、扭曲2例,吻合口胆漏2例,供体胆管与受体胆管直径差异过大1例,胆总管轻度扩张1例。该组无胆道出血患者,其中胆管炎性狭窄发生率最高,为36.36%(8/22);其次为胆管吻合口狭窄,为13.64%(3/22)。内镜治疗治愈率为63.64%(14/22),好转率为31.82%(7/22)。治疗方式选择:乳头球囊扩张(EPBD)17.65%(6/34),乳头括约肌切开EST35.29%(12/34),扩张胆管41.18%(14/34),鼻胆管引流(ENBD)70.59%(24/34),胆管支架引流(ERBD)26.47%(9/34),取石11.76%(4/34),胆管冲洗29.41%(10/34)。结论治疗性ERCP已成为成人原位肝移植术后胆道并发症非手术治疗的首选方式和主要方法,具有创伤小、治疗效果可靠、诊疗一体化等优点,逐渐成为肝移植术后胆道并发症的重要治疗手段。【Objective】To explore endoscopic retrograde cholangiopancreatography （ERCP） images finding and endoscopic treatment of biliary complications after adult orthotopic liver transplantation （BCAOLT）,to assess the effectiveness of ERCP imaging diagnosis and endoscopic treatment.【Methods】22 cases of biliary complications after adult orthotopic liver transplantation with ERCP 34 times were treated correspondingly according to the results of ERCP.【Results】21 cases of 33 successful,ERCP success rate was 97.06% （33/34）.The reasons for biliary complications were definite after ERCP in all cases.The location of biliary complications occurred in part as follows：donor liver,donor and receptor bile duct,bile duct anastomotic stoma and duodenal papilla.5 cases of bile duct stricture with cholangitis;3 cases of extrahepatic and intrahepatic bile duct stricture with cholangitis,combined with biliary sludge formation or cholelithiasis;bile duct anastomotic stricture in 3 cases;duodenal papillary dysfunction in 2 cases;duodenal papillary stenosis in 2 cases;bile duct was too long and twisted in 2 cases;bile leakage in 2 cases;donor and receptor bile duct diameter was too large difference in 1 case;light simplex choledochectasia in 1 case.No hemobilia in patients.Bile duct stricture with cholangitis incidence rate was the highest in this group,36.36% （8/22）;followed by bile duct anastomotic stricture,13.64%（3/22）.Endoscopic cure rate was 63.64% （14/22）;improvement rate was 31.82% （7/22）.The choice of treatment：endoscopic papillary ballon dilation （EPBD） 17.65% （6/34）,endoscopic sphincterotomy（EST） 35.29% （12/34）,bile duct expansion 41.18%（14/34）,endoscopic nasobiliary drainage （ENBD） 70.59% （24/34）,endoscopic retrograde biliary drainage （ERBD） 26.47%（9/34）,extraction of bile duct stones 11.76% （4/34）,bile duct irrigation 29.41% （10/34）.【Conclusion】Endoscopic therapy has become main and preferred method of nonoperative treatment for biliary com

关 键 词：ERCP 原位肝移植 胆道并发症 内镜治疗 

分 类 号：R617[医药卫生—外科学]