肝移植术后胆道并发症ERCP表现及内窥镜介入治疗

ERCP findings and endoscopic guided interventional therapy of biliary complications after liver transplantation

目的探讨肝移植术后胆道并发症的原因及影像学表现,并对部分并发症进行内窥镜介入治疗,以提高肝移植的成功率。方法通过十二指肠镜逆行胰胆管造影(ERCP)检查对肝移植术后胆道异常改变11例资料进行回顾性分析,并根据检查结果做相应的内窥镜下介入治疗。结果通过ERCP检查,对11例肝移植术后患者出现梗阻性黄疸原因得到明确诊断,其中,胆道胆泥形成2例,胆管吻合口狭窄6例,胆道腹腔漏3例。并对2例胆道胆泥进行了乳头括约肌切开(EST)+网蓝胆泥取出术;5例吻合口狭窄行气囊扩张或塑料内支架内引流(ERBD)及2例胆道腹腔漏行鼻胆管引流治疗(ENBD),治疗效果确切,经有针对性的预防和治疗后,除2例胆道腹腔漏分别于肝移植术后6月及11月病死和1例因胆管吻合口处完全阻塞未能放置内支架引流管,导致肝内胆汁淤积症并肝硬化及肝功能失代偿病死外,其余患者均痊愈出院,现仍长期存活,总生存率为72.7%。结论肝移植术后一旦怀疑胆道并发症时应及时行ERCP检查,并根据检查结果做内窥镜介入治疗。胆道并发症的及时发现和处理将可能使患者较快痊愈。

Objective To explore the imaging findings and the causes of biliary complications after liver transplantation and to perform the endoscopic guided interventional therapy for partial complications so as to elevate the successful rate of liver transplantation. Methods The data of endoscopic retrograde cholangiopancreatography（ERCP）in 11 patients with hiliary anomalies which were secondary to liver transplantation were analyzed retrospectively and then the endoscopic guided interventional therapy was performed on the basis of ERCP. Results ERCP definitely demonstrated the causes of obstructive jaundice in all patients after liver transplantation. Of whom, biliary mud formation was found in 2 cases, biliary anastomotic stricture in 6, and fistula of biliary tract - abdominal cavity in 3. Two patients with biliary mud underwent the extracting procedure by using papillary sphincterotomy（EST）plus net rail. Five patients with anastomotic stricture underwent endoscopic retrograde biliary drainage（ERBD）by balloon dilatation or by plastic stent placement, and two patients with fistula of biliary tract- abdominal cavity underwent endoscopic nosobiliary drainage（ENBD）. Except 2 patients with fistula of biliary tract - abdominal cavity died at sixth - and eleventh month after liver transplantation respectively, and one case without ERDB died soon after transplansplantation due to cholestasis associated with cirrhosis and liver function failure, other 8 cases were basically recovered and still lived up to now. The overall therapeutic rate was 72.7%. Conclusion After liver transplantation, if one once biliary complications are suspected it is necessary to perform ERCP and in which to perform endoscopic guided interventional therapy. Timely finding and treating of biliary complications can accelerate the recovery of the patients.