ERCP治疗肝移植术后胆道并发症的研究  

ERCP management for biliary complications after liver transplantation:a single-center experience

作　　者：张章 陈肖佳 曹婷婷 胡欣怡 王帆[1] 方军[1] 赵秋[1] ZHANG Zhang;CHEN Xiao-jia;CAO Ting-ting;HU Xin-yi;WANG Fan;FANG Jun;ZHAO Qiu(Department of Gastroenterology,Zhongnan Hospital of Wuhan University,Wuhan,430071,China)

机构地区：[1]武汉大学中南医院消化内科,430071

出　　处：《现代消化及介入诊疗》2022年第8期947-950,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：疑难病症诊治能力提升工程(肿瘤学)——注册临床试验项目(ZLYNXM202017)。

摘　　要：目的本研究旨在回顾本研究中心行经内镜逆行胰胆管造影(ERCP)治疗肝移植后胆道并发症的经验。方法回顾性分析2017年4月到2021年4月武汉大学中南医院因肝移植术后胆道并发症行ERCP治疗患者的临床资料,根据患者当次ERCP指征分为吻合口狭窄组、胆结石组和胆漏组。收集不同类型胆道并发症患者的一般资料及每次行ERCP时的实验室检查、治疗结果,并对数据进行统计分析。结果52位患者共行108例次ERCP,48人插管成功,共101例次(93.5%),治疗成功100例次(99.0%),中位操作次数为2(1~2)例次/人。吻合口狭窄病人主要行支架置入、鼻胆管引流、胆道扩张(包括球囊扩张及金属探条扩张)治疗。肝移植术后,胆漏的发病时间最早,中位时间47.5(16~793)d;发生吻合口狭窄的时间次之,中位时间390(8~2105)d;发生胆管结石的时间最晚,中位时间855(125~2749)d;其差距具有统计学意义(P<0.01)。患者经ERCP治疗后肝功能指标(ALT、AST、TBiL、GGT)均较治疗前明显下降,差异有统计学意义(P<0.01)。发生术后高淀粉酶血症19例次(18.8%),全部经对症治疗后好转出院。结论肝移植术后胆漏的发病时间早于吻合口狭窄和胆管结石。对于肝移植术后胆道并发症,ERCP是一种安全、有效的治疗手段。建议在肝移植术后胆道并发症的治疗中优先选择ERCP,手术和经皮肝穿刺胆道引流术(PTCD)应作为替代治疗,以优化治疗流程。Objective This study aims to evaluate our experience in the treatment of biliary complications(BC)with Endoscopic Retrograde Cholangiopancreatography(ERCP)after liver transplantation(LT)in a single-center study.Methods All patients who underwent therapeutic ERCP for BC at Zhongnan Hospital of Wuhan University from April 2017 to April 2021 after LT were reviewed.The procedures were divided into anastomotic stricture group,biliary leak group,and biliary stones group due to their indications for ERCP.The demographic characteristics of patients and the laboratory examination,treatment outcomes were statistically analyzed.Results A total of 108 ERCP procedures were performed in 52 patients.48 patients with 101 procedures(93.5%)successfully passed the guidewire through the biliary duct,with a median of 2(1~2)times per person.Among the 101 technical successful procedures,100 ERCPs achieved clinical success(99.0%).After liver transplantation,the earliest onset was bile leakage with 47.5(16-793)days,followed by anastomotic stricture was 390(8-2105)days,and biliary stones occurred latest with 855(125-2749)days.The difference was statistically significant(P<0.01).The liver function value decreased significantly after ERCP treatment(P<0.01).Postoperative pancreatitis occurred in 19 cases(18.8%),all of them were cured after symptomatic treatment.Conclusion The onset of the biliary leak is earlier than anastomotic stricture and biliary stones.ERCP was a safe and effective approach for the treatment of BC after LT with a high-resolution rate.It is suggested that ERCP should be given priority in the treatment of biliary complications after liver transplantation,and surgery and percutaneous transhepatic cholangiodrainage(PTCD)should be used as an alternative treatment to optimize the treatment process.

关 键 词：肝移植 经内镜逆行胰胆管造影 胆道疾病 

分 类 号：Q486[生物学—生理学] R575[医药卫生—消化系统]