ERCP在原位肝移植术后早期胆道并发症中的应用  

Application of ERCP in biliary complications early after orthotopic liver transplantation

作　　者：郭亚飞 黄德好 吴维 黄强 刘连新 Guo Yafei;Huang Dehao;Wu Wei;Huang Qiang;Liu Lianxin(Organ Transplant Center,the First Affiliated Hospital,University of Science and Technology of China,Hefei 230001,China;Department of Biliary and Pancreatic Surgery,the First Affiliated Hospital,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院器官移植中心,合肥230001 [2]中国科学技术大学附属第一医院胆胰外科,合肥230001

出　　处：《中华肝脏外科手术学电子杂志》2020年第4期360-364,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：中国科学技术大学2019年度“科大新医学”联合基金(WK9110000055)。

摘　　要：目的探讨ERCP在原位肝移植术后早期胆道并发症诊治中的应用价值。方法回顾性分析2017年4至2019年4月中国科学技术大学附属第一医院收治的39例肝移植受者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男27例,女性12例;年龄19~63岁,中位年龄48岁。脑死亡供肝9例,心脏死亡供肝23例,脑-心双死亡供肝7例。手术方式均为同种异体经典原位肝移植;38例行胆管端端吻合,1例行胆管-空肠Roux-en-Y吻合。对术后并发症依据Clavien-Dindo分级标准进行分级,分析早期胆道并发症的诊断和治疗。结果术后早期胆道并发症4例,发生率10%(4/39),其中胆管吻合口漏2例,单纯胆道吻合口狭窄1例,缺血性胆道病变(ITBL)合并胆道铸形、反复胆道逆行感染1例。4例患者均成功实施ERCP治疗,共计16例次。2例吻合口漏患者经鼻胆管引流及胆道支架置入后治愈;1例单纯胆道吻合口狭窄患者经支架置入后恢复良好;1例ITBL合并胆道铸形、反复胆道逆行感染患者经7次ERCP治疗后恢复良好。ERCP术后一过性高淀粉酶血症1例,保守治疗后治愈。结论 ERCP在原位肝移植术后早期胆道并发症的诊断及治疗中效果肯定,安全可靠,可作为非手术治疗的首选方式。Objective To evaluate the use of endoscopic retrograde cholangiopancreatography(ERCP)in biliary complications early after orthotopic liver transplantation.Methods Clinical data of 39 liver transplant recipients who were admitted in the First Affiliated Hospital,University of Science and Technology of China from April 2017 to April 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,27 patients were male and 12 female,aged 19-63 years,with a median of 48 years.There were 9 cases of donation after brain death,23 cases of donation after cardiac death and 7 cases of donation after brain death awaiting cardiac death.Patients underwent allograft classic orthotopic liver transplantation,including 38 case of end-to-end bile duct anastomosis,and 1 case of duct-jejunum Roux-en-Y anastomosis.Postoperative complications are graded according to Clavien-Dindo classification.Diagnosis and treatments for early biliary tract complications were analyzed.Results 4 cases developed early biliary tract complications after operation with an incidence of 10%(4/39),including 2 cases of bile duct anastomotic leakage,1 case of simple bile duct anastomotic stenosis,1 case of ischemic-type biliary lesion(ITBL)combined with biliary cast and recurrent retrograde biliary tract infection.ERCP were successfully performed in 4 patients for a total of 16 case-times.2 cases with anastomotic leakage recovered after nasobiliary drainage+bile duct stenting.1 case with simple biliary anastomotic stenosis recovered well after stenting and 1 case with ITBL combined with biliary cast and recurrent retrograde biliary tract infection recovered well after 7 attempts of ERCP.After ERCP,1 case developed transient hyperamylasemia and was cured after conservative treatment.Conclusions ERCP is effective,safe in the diagnosis and treatment of biliary complications in the early period after orthotopic liver transplantation,and can be used as a preferred method of non-

关 键 词：肝移植 胰胆管造影术 内窥镜逆行 手术后并发症 缺血性胆道病变 

分 类 号：R657.3[医药卫生—外科学]