利用纤维胆道镜诊断和治疗肝移植后胆道并发症六例

Diagnosis and treatment of 6 patients with biliary complications following orthotopic liver transplantation by choledochofiberscopy

目的探讨纤维胆道镜在肝移植术后胆道并发症的诊断和治疗中的作用.方法对6例肝移植术后出现反复胆系感染、梗阻性黄疸的患者,通过T管窦道,采用纤维胆道镜进行治疗,同时记录术后不同时期纤维胆道镜的观察结果.结果在移植术后3～5个月的患者,胆道镜下可见胆道内满视野'柳絮状物',胆管壁苍白,或粗糙不平.在术后6、11、18个月的患者,纤维胆道镜观察到胆管内呈条索状、柱状的褐色结石,多位于肝门处,胆管吻合口有不同程度的狭窄;胆管壁粗糙不平,黏膜明显充血,触之易出血.通过纤维胆道镜能方便地取出胆管中的柳絮状物和结石.结论通过T管窦道,利用纤维胆道镜观察移植肝胆管内情况的同时,能方便地进行治疗.

Objective To explore the role of choledochofiberscopy in the diagnosis and treatment of biliary complication after orthotopic liver transplantation. Methods The patients with continuous biliary infection and obstructive jaundice in 6 cases subject to orthotopic liver transplantation were treated by choledochofiberscopy through T tube sinus tract. The findings from choledochofiberscope at different periods after operation were recorded. Results Three to five months after operation, there were a lot of flocs in the bile duct cavity under the choledochofiberscopy, and mucous membrane of bile duct was pale or coarse. On the postoperative month 6, 11 and 18, choledochofiberscopy revealed there were funicular, columned and brown biliary stones in bile duct cavity which mostly located in porta hepatis, and there existed stenosis in anastomotic stoma of bile duct to varying degrees; the wall of bile duct was coarse, with congestion of the mucous membrane. The flocs and stones could be extracted conveniently by the choledochofiberscope. Conclusion We can observe the transplanted liver＇s bile duct through the T tube sinus tract by the choledochofiberscopy and treat the biliary complications conveniently.