SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用  

Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation

作　　者：王旋 李甫[1] 唐睿[1] 黄金鑫[1] 刘加康 龚彪 张晞文[1] Wang Xuan;Li Fu;Tang Rui;Huang Jinxin;Liu Jiakang;Gong Biao;Zhang Xiwen(Department of Hepatobiliary and Pancreatic Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China;不详)

机构地区：[1]上海中医药大学附属曙光医院肝胆胰外科,上海201203 [2]上海中医药大学附属曙光医院消化医学部内镜中心,上海201203

出　　处：《器官移植》2023年第3期404-410,共7页Organ Transplantation

基　　金：国家自然科学基金(81904017)。

摘　　要：目的探讨SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用效果。方法回顾性分析369例因成人原位肝移植术后胆道并发症首次行内镜逆行胰胆管造影术(ERCP)治疗患者的临床资料。分析接受SpyGlass治疗患者的术前情况、术中表现、治疗转归及并发症。结果56例患者接受SpyGlass治疗,主要术前体征包括腹部不适38例、发热8例、黄疸6例、皮肤瘙痒4例。18例患者行超声检查,提示胆总管狭窄,肝内胆管明显扩张。56例患者术前均行磁共振胰胆管成像(MRCP)检查,其中胆总管狭窄合并结石36例、单纯胆总管狭窄16例、考虑肿瘤可能4例,均具有明确的SpyGlass治疗指征。56例接受SpyGlass治疗患者中,吻合口狭窄合并结石34例、单纯吻合口狭窄12例、单纯胆道结石1例、肿瘤4例。48例SpyGlass操作成功者术后48 h丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、碱性磷酸酶、总胆红素水平均较术前下降(均为P<0.05)。56例经SpyGlass治疗患者未出现严重并发症。结论SpyGlass在肝移植术后复杂胆道并发症治疗中能够明显提高治疗成功率,安全性较高,值得推广应用。Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation.Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography(ERCP)for the first time were retrospectively analyzed.Preoperative conditions,intraoperative manifestations,treatment outcomes and complications of patients treated with SpyGlass system were analyzed.Results Fiftysix patients were treated with SpyGlass system.The main preoperative symptoms included abdominal discomfort in 38 cases,fever in 8 cases,jaundice in 6 cases and skin itching in 4 cases.Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation.Preoperative magnetic resonance cholangiopancreatography(MRCP)of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones,16 cases of common bile duct stenosis alone and 4 cases of suspected tumors.All patients had definite indications for SpyGlass system treatment.Among 56 patients treated with SpyGlass system,34 cases were diagnosed with anastomotic stricture complicated with stones,12 cases of anastomotic stricture alone,1 case of biliary stone and 4 cases of tumors.Among 48 cases who were successfully treated,the levels of alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels(all P<0.05).No severe complications occurred in 56 patients treated with SpyGlass system.Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation,which is worthy of promotion and application.

关 键 词：SpyGlass内镜直视系统 肝移植 胆道并发症 内镜逆行胰胆管造影术(ERCP) 磁共振胰胆管成像(MRCP) 吻合口狭窄 胆道结石 胆漏 

分 类 号：R617[医药卫生—外科学] R575[医药卫生—临床医学]