肝移植术后胆泥、胆铸型及胆结石病因及治疗

Diagnosis and treatment of biliary sludge, cast and stone following liver transplantation

目的:探讨肝移植术后胆泥、胆铸型和胆道结石的病因和治疗。方法:回顾分析2003年2月～2004年1月开展81例次全肝移植患者临床资料,对9例胆道胆泥、胆铸型和胆道结石患者的病因进行分析,并讨论胆泥、胆铸型和胆道结石的诊断和治疗。结果:发生胆道胆泥、胆铸型和胆道结石9例,发生率为11.1%(9/81),其中坏死絮状物2例、胆泥和胆铸型5例、胆结石2例。该组胆泥、胆铸型和胆道结石7例经T管冲洗、ERCP等非手术治疗,3例好转,其余4例治疗后效果不明显,行手术治疗,4例胆道取出胆泥、胆铸型、胆石,放置T管其中2例好转,2例疗效不佳而死亡。3例肝动脉栓塞伴胆泥患者中2例行再次肝移植后现存活,另外1例患者反复经ERCP下置鼻胆管冲洗治疗,现存活。结论:肝移植术后胆泥、胆铸型和胆结石的形成重要原因有缺血再灌注损伤、排斥反应、感染和胆汁动力学的改变。B超、胆道造影能及时诊断。T管冲洗、ERCP术及外科手术是常用的治疗手段。缩短缺血时间,保护胆道血供,积极防治感染和排斥反应是减少或者避免胆道并发症的重要措施。

Objective：To investigate etiology and treatment of biliary sludge, cast and stone following orthotopic liver transplantation （OLT）. Methods：A review was made using the data collected from 81 cases of OLTs performed in our center from February 2003 to January 2004 retrospectively. Etiological factors of 9 cases of biliary sludge, cast and stone following OLT were analyzed. Diagnosis and treatment of biliary sludge, cast and stone following OLT were discussed, Results：Nine cases of biliary sludge, east and stone were diagnosed and the incidence rate was 11.1%. Of these, 5 were biliary sludge and cast, 2 were bile stone, 2 were necrotic debris. Three cases of biliary sludge and biliary cast were resolved by non-operatlve treatment. The other 4 cases were reoperated, and 2 resolved and 2 cases died. Two cases with hepatic artery embolism received retransplantation and survived. The other one with hepatic artery embolism was ameliorated with nasobiliary drainage by ERCP. Conclusion：Biliary injury and ischemia reperfusion injury, exclasive reaction, infection and changes of bile dynamics are the important factors causing biliary sludge, cast and stone following OLT. Doppler and bile duct contrast can make diagnosis timely. Irrigation through T tabe, ERCP and operation are the common treatments for the patients. Shortening the time of cold and heat ischemia reperfusion injury of liver, reducing the injury of the blood supply of donor biliary, actively preventing and early treating infection and exclusive reaction may reduce the incidence rate of biliary sludge, cast and stone following OLT.