原位肝移植术后胆道并发症经“T”形引流管及其瘘管的介入治疗

Interventional Management Through T Tube or Its Fibrous Tract for Biliary Tract Complications After Orthotopic Liver Transplantation

【目的】探讨原位肝移植术后胆道并发症经“T”形引流管及其瘘管的介入治疗措施。【方法】回顾性研究161例原位肝移植的临床资料,对出现胆道并发症的患者分别行胆道扩张成形术,引流术和支架置入术治疗。【结果】161例病人术后共发生胆道并发症16例(10%)。其中胆道狭窄合并胆瘘2例,吻合口狭窄1例,肝内胆管和胆总管多发狭窄5例,肝内胆管和胆总管多发狭窄合并胆泥形成8例。2例胆道狭窄合并胆瘘病人和4例肝内胆管和胆总管多发狭窄患者,经球囊扩张成形术和胆道引流后痊愈。吻合口狭窄1例治疗后,黄疸明显减退。1例胆道狭窄球囊扩张治疗后出现肝内血肿,行再次肝移植。6例肝内胆管和胆总管多发狭窄合并胆泥形成的病人,经反复多次的球囊扩张成形治疗后,狭窄明显减轻,黄疸缓解。1例肝内胆管和胆总管多发狭窄合并胆泥形成的病人,对狭窄明显的总肝管置入支架治疗,由于大量胆泥造成支架内狭窄。另1例球囊扩张成形治疗后,狭窄仍反复存在,黄疸无缓解。【结论】肝移植术后胆道并发症经“T”形引流管及其瘘管的介入治疗不仅操作方便,而且痛苦小成功率高,为有效的介入治疗方法。

[Objective]To discuss the interventional management of biliary tract complications after orthotopic liver transplantation. [Methods]A review was made of 161 patients＇ data collected retrospectively. The patients suffering the biliary tract complications received biliary balloon dilation, bile drainage and biliary stent. [Results]The analysis of these 161 patients showed that 16 （10%） cases had complications： strictures and leaks in 2, biliary anastomotic stricture in 1, multiple strictures at biliary tract in 5, multiple strictures with sludge at biliary tract in 8. After biliary balloon dilation, 2 cases of stricture with leaks and 4 cases of multiple strictures were recovered. One multiple stricture patient had hepatic hematoma and received second transplantation. Six cases of multiple strictures with biliary sludge were catabatic. One case of multiple strictures with biliary sludge received the stent treatment, but much sludge blocked the tract and stent. Only one case was not catabatic. [Conclusion]The interventional management through T tube or its fibrous tract is efficient, convenient, and minimally invasive.