肝移植术后中远期胆道并发症47例临床分析  

Clinical analysis of 47 cases with mid- and long-term biliary complications after liver transplantation

作　　者：蒋伟伟[1] 李俊[2] 陈虹[2] 沈中阳[2] 程明亮[1] 范铁艳[2] 王旭[2] 张庆[2] 陈新国[2] 徐光勋[2] 

机构地区：[1]贵阳医学院,550004 [2]武警总医院器官移植研究所

出　　处：《器官移植》2015年第2期93-97,共5页Organ Transplantation

基　　金：国家高技术发展计划(863计划)项目(2012AA021006)

摘　　要：目的探讨肝移植术后中远期胆道并发症的发生、治疗及转归情况。方法回顾性分析2002年4月至2012年2月在北京武警总医院器官移植研究所接受原位肝移植的651例患者的临床资料,分析肝移植术后中远期胆道并发症的发生、治疗与转归情况。结果 651例肝移植患者中,发生术后中远期胆道并发症者47例,发生率为7.2%,平均发病时间21个月。47例中远期胆道并发症患者共治疗48例次。单纯抗炎治疗9例次,胆道镜取石、铸型或放置支撑管14例次,内镜下逆行性胰胆管造影术(ERCP)取石、扩管或放置支架13例次[其中1例治疗未成功改行经皮经肝胆道引流术(PTCD)后治愈],PTCD引流7例次,抗炎联合胆道镜或PTCD治疗共5例次。治疗总体有效率为92%。治疗无效者3例,其中2例行再次肝移植,1例死亡。结论肝移植术后中远期胆道并发症有一定的发生率,其治疗需根据胆道并发症类型及病变程度选择不同的治疗方法,多数疗效良好,必要时需进行再次肝移植。Objective To investigate the incidence, treatment and outcome of mid- and long-term biliary complications after liver transplantation. Methods Clinical data of 651 patients who underwent liver transplantation at General Hospital of Armed Police Forces from April 2002 to February 2012 were retrospectively studied to analyze the incidence, treatment and outcome of mid- and long-term biliary complications after liver transplantation. Results Among 651 liver transplant eases, 47 patients （7.2%） developed mid- and long-term biliary complications. The mean time of onset was 21 months. Forty seven patients underwent 48 cases of treatment in total. Nine cases received anti-inflammatory therapy alone. Fourteen cases were treated with choledochoscope lithotomy, eholedochoscope biliary cast or placing the biliary support tube. And 13 cases underwent endoscopic retrograde cholangiopanereatography （ERCP） nephrolithotomy, expanding the bile duct or placing the biliary support tube, including 1 patient was switched to percutaneous transhepatic cholangial drainage （PTCD） due to ERCP failure. Seven cases received drainage by PTCD and 5 cases were treated with anti-inflammatory therapy combined with choledochoscope or PTCD. The total efficacious rate was 92%. Among 3 invalid patients, two patients were treated with secondary liver transplantation and one died. Conclusions The mid- and long-term biliary complications probably occur after liver transplantation. Individualized therapies should be chosen based upon the types and severity of biliary complications, which yields relatively high efficacious rate. Secondary liver transplantation should be performed as necessary.

关 键 词：肝移植 胆道并发症 微创治疗 

分 类 号：R617[医药卫生—外科学]