原位肝移植术后胆管狭窄的治疗(附43例报告)

Treatment of biliary stricture after orthotopic liver transplantation:a report of 43 cases

目的探讨原位肝移植(OLT)术后胆管狭窄(BS)治疗方法和疗效。方法回顾性分析中山大学附属第三医院肝脏移植中心2003年10月至2005年10月收治的43例OLT术后BS的治疗方法及其疗效。43例BS的治疗方法主要包括经十二指肠镜逆行胆管造影(ERC)、经皮肝穿刺胆管造影(PTC)、经T管的胆管介入治疗、胆肠吻合术、肝动脉内支架术及再次肝移植术。结果43例BS总治愈率为48.8%(21/43),好转率为30.2%(13/43),总有效率为79.0%(34/43)。41例BS的介入治疗治愈率为34.1%(14/41),好转率为31.7%(13/41),总有效率为65.8%(27/41)。吻合口型、肝外型、肝内型及肝内外混合型BS的总治愈率分别为100%(5/5)、64.3%(9/14)、50.0%(1/2)及28.6%(6/21),其介入治疗的治愈率分别为80.0%(4/5)、64.3%(9/14)、50.0%(1/2)及0。12例BS行再次肝移植术的治愈率为50.0%(6/12)。结论目前OLT术后BS总体疗效尚不理想。BS介入治疗效果与其类型密切相关,吻合口型疗效最好,肝外型和肝内型次之,肝内外混合型疗效最差。再次肝移植是治疗难治性BS的有效方法,但要选择好手术时机。

Objective To investigate the treatment and its efficacy of biliary stricture （BS） after orthotopic liver transplantation （OLT）. Methods The treatment and efficacy of 43 patients with BS after OLT from October 2003 to October 2005 were analyzed retrospectively. The patients received interventional therapy through endoscopic retrograde cholangiography （ERC）, percutaneous transhepatic cholangiography （PTC） or T tube, cholangioenterostomy, hepatic artery stent and liver retransplantation. Results The total cure rate of 43 patients with BS was 48. 8% （21/43）, the improvement rate was 30.2% （ 13/43 ） ,and the total effective rate was 79.0% （34/43）. The cure rate of interventional therapy of 41 patients with BS was 34. 1% （ 14/41 ）, the improvement rate was 31.7% （ 13/41 ）, and the total effective rate was 65. 8% （27/41 ）. The total cure rate of anastomotic, extrahepatic, intrahepatic, and mixed type BS was. 100 % （ 5/5 ）, 64. 3 % （ 9/ 14） ,50. 0% （1/2） ,and 28.6% （6/21） respectively. And that of interventional therapy was respectively 80. 0% （4/5）, 64. 3% （9/14） ,50. 0% （1/2） and 0. The cure rate of liver retransplantation of 12 BS was 58% （6/12）. Conclusion The therapeutic efficacy of BS after OLT is not ideal nowadays. The therapeutic efficacy of intaventional therapy of BS is related to its type. The therapeutic efficacy of anastomotic BS is the best, followed by extrahapatic BS, intrahepatic BS and mixed BS. Liver retransplantation is effective in refractory BS. The optimal timing is the key for a successful liver retransplantation.