ERCP在治疗肝移植术后胆道狭窄中的应用价值  

Application value of ERCP in biliary stricture following liver transplantation

作　　者：巫织娥[1] 顾华英[1] 王艺穗 郑丰平[1] 郭云蔚[1] 林颖[1] 

机构地区：[1]中山大学附属第三医院消化内镜中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2015年第3期173-175,共3页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2012B061700072)

摘　　要：目的探讨ERCP在肝移植术后胆道狭窄治疗中的应用价值。方法回顾性分析2008年1月至2014年1月在中山大学附属第三医院采用ERCP治疗的47例肝移植术后胆道狭窄患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男41例,女6例;年龄24~62岁,中位年龄51岁;吻合口狭窄31例,非吻合口狭窄16例。患者行ERCP,确定胆道狭窄部位后在导丝的支撑下行乳头肌切开术,通过导丝应用扩张导管或柱状球囊行狭窄段逐级扩张。根据胆道造影情况决定行鼻胆管引流术或塑料支架放置术。疗效评定标准分为治愈、好转、无效、再狭窄。结果 47例患者均成功完成ERCP治疗,共治疗112次,鼻胆管引流79人次,放置支架33人次。31例吻合口狭窄患者中,治愈28例,好转3例。16例非吻合口狭窄患者中,治愈5例,好转3例,无效8例。本组患者的总治愈率为70%（33/47）,有效率83%（39/47）;并发症发生率9%（4/47）,其中轻型胰腺炎2例,高淀粉酶血症1例,胆道感染1例。结论 ERCP治疗肝移植术后胆道狭窄具有安全、可靠、诊疗一体化等优点,是非手术治疗的首选方式。ObjectiveTo investigate the application value of endoscopic retrograde cholangiopancreatography （ERCP） in biliary stricture following liver transplantation （LT）.MethodsClinical data of 47 patients with biliary stricture following LT treated with ERCP in the Third Affiliated Hospital of Sun Yat-sen University between January 2008 and January 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 47 patients, 41 were males and 6 were females with the age ranging from 24 to 62 years old and the median of 51 years old. Anastomotic stricture was observed in 31 cases and non-anastomotic stricture in 16 cases. ERCP was performed on patients to localize biliary stricture and then papillotomy was performed under the support of guide wire. The stricture was dilated progressively by dilating catheter or columnar balloon through the guide wire. Endoscopic nasobiliary drainage or plastic stent placement was chosen according to the ERCP results. The evaluation of curative effect was graded by cure, improvement, inefifcacy and restenosis.ResultsAll the 47 patients underwent ERCP successfully with totally 112 times. Nasobiliary drainage was performed 79 person-times,＆amp;nbsp;stent placement 33 person-times. Among the 31 patients with anastomtic stricture, 28 were cured and 3 were improved. Among the 16 patients with non-anastomtic stricture, 5 were cured, 3 were improved, and 8 were ineffective. The total cured rate of all the patients was 70% （33/47） and the effective rate was 83% （39/47）. The incidence of complications was 9% （4/47）, including 2 cases of mild pancreatitis, 1 case of hyperamylasemia and 1 case of biliary tract infection.ConclusionERCP is safe, effective and integrated in diagnosis and treatment for biliary stricture following LT, which is the ifrst choice for non-surgery treatment.

关 键 词：肝移植 胆道并发症 胰胆管造影术 内窥镜逆行 

分 类 号：R657.3[医药卫生—外科学]