经皮肝穿刺和经内镜介入治疗肝移植术后胆管狭窄疗效的比较  

Comparsion of PTC and ERCP for the treatment of biliary tract stricture after liver transplantation

作　　者：汪根树[1] 许长谋[2] 何可可[2] 郑丰平[3] 姜在波[2] 李华[1] 许赤[1] 易述红[1] 张剑[1] 杨扬[1] 陈规划[1] 单鸿[2] 

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介入科,广州510630 [3]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

出　　处：《中华普通外科杂志》2012年第11期920-923,共4页Chinese Journal of General Surgery

基　　金：国家重点基础研究发展计划基金资助项目（973计划）（2009CB522404）;广东省第一批科学事业费计划基金资助项目（20118060300002）;国家自然科学基金资助项目（81170422）

摘　　要：目的 比较经皮肝穿刺胆管造影（percutaneous transhepatic cholangiography,PTC）和内镜逆行胆胰管造影（endoscopic retrograde cholangiopancreatography,ERCP）介入治疗肝移植术后胆管狭窄的疗效.方法 回顾性分析132例肝移植术后胆管狭窄经PTC（PTC组）和ERCP（ERCP组）介入治疗的疗效.99例接受经PTC介入治疗,59例接受经ERCP介入治疗,26例因ERCP介入治疗疗效不佳或失败转行PTC介入治疗.采用X2经验比较两者的手术成功率、并发症率、治愈率和有效率.结果 PTC组和ERCP组胆管狭窄的类型差异有统计学意义（P＜0.01）,PTC组以非吻合口狭窄为主,ERCP组以吻合口狭窄为主；PTC介入手术成功率高于ERCP介入手术（100％比97％）（P＜0.01）,并发症发生率低于ERCP介入手术（15％比39％）（P＜0.01）,两组的总治愈率和有效率差异无统计学意义（32.3％比45.8％,94.9％比88.1％）（P＞0.05）.PTC和ERCP介入治疗吻合口型、肝外型、肝门型和弥漫型胆管狭窄的治愈率和有效率差异无统计学意义（P＞0.05）.结论 经PTC和ERCP介入治疗肝移植术后胆管狭窄的疗效相当,可作为肝移植术后胆管狭窄尤其是非吻合口狭窄的一线治疗方法.Objective To compare the efficacy of percutaneous and endoscopic treatment for the biliary stricture（BS） after liver transplantation （LT）.Methods The result of percutaneous transhepatic cholangiography （PTC） and drainage （ PTC group） and endoscopic retrograde cholangiopancreatography （ERCP group） for the BS in 132 post-LT patients were analyzed retrospectively.Ninety-nine patients received PTC treatment,and 59 patients received ERCP treatment,26 patients converted to PTC treatment because of the poor efficacy or failure of the ERCP treatment.The operation success rate,complication rate,cure rate and remission rate of the two groups were compared with X2 test.Results The BS types of PTC and ERCP group were different significantly（ P 〈 0.01 ）,with more non-anostomotic stricture in PTC group and more anostomotic stricture in ERCP group.The operation success rate of PTC group was higher than of ERCP group（ 100% vs 97% ） （P 〈0.01 ）,and the complication rate of PTC group was lower than of ERCP group.The overall cure and remission rate of PTC and ERCP group were not different significantly（32.3% vs 45.8%,94.9% vs 88.1% ） （P 〉0.05）.The cure and remission rate of PTC and ERCP treatment for each subtype of BS were not different significantly （ P 〉 0.05 ）.Conclusions The efficacy of PTC treatment for the post-LT BS is equivalent to that of ERCP treatment.PTC can be considered the first-line option for the post-LT BS.

关 键 词：肝移植 胆管疾病 胆管造影术 胰胆管造影术 内窥镜逆行 

分 类 号：R657.3[医药卫生—外科学]