肝移植术后胆道并发症的内镜介入治疗

ENDOSCOPIC MANAGEMENT OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION.

目的 评估肝移植术后胆道并发症内镜介入治疗的价值。方法 1996年5月至2 0 0 5年2月进行的肝移植16 6例中,肝移植术后胆道并发症2 7例;其中14例进行内镜介入治疗2 1次,男性8例,女性6例,平均年龄4 5 .8岁。ERC下放置鼻胆管外引流3例,放置支架内引流6例,气囊扩张1例,乳头括约肌切开1例,ERCP 3例。结果 5 0 % (1/ 2 )胆瘘、5 0 % (4/8)胆道狭窄内镜介入治疗有效;75 % (3/ 4 )管型综合症经ERCP诊断。结论 ERC有助于肝移植术后胆道并发症诊断,治疗有效、安全,是肝移植术后胆道并发症首选治疗方法。

Objective The aim of the study was to assess the effectiveness of ERCP as a diagnostic and treatment tool in the management of biliary tract OLT complications. Methods The diagnostic and treatment effectiveness of ERCP in the management of biliary tract OLT complication in 166 patients from 5/1996 to 2/2005 was reviewed. 27/166 (16.3% ) OLT patients presented biliary complications. 14 patients (8 men and 6 women,mean age of 45.8 years) underwent a total of 21 ERCP. Endoscopic retrograde cholangiography (ERC) with nose bile tube in 3 patients,with biliary stenting in 6 patients,with air pocket expand in one patients,with endoscopic sphincterotomy(EST) in one patients, Endoscopic retrograde cholangiopancreatography (ERCP) in 3 patients be successfully applied for post-OLT biliary complications.Result The final treatment efficacy was 50% (1/2 patients), 50% (4/8 p.) for patients with biliary leaks , biliary strictures,respectively. ERCP in 75%(3/4) patients with biliary casts can be successfully applied. Conclusion Because of its availability, diagnostic accuracy, treatment efficacy and safety, ERCP should be used as the first-line procedure for treatment of biliary tract complications after OLT.