微创外科技术在原位肝移植术后胆道并发症的应用价值

Assess the Minimally Invasive Techniques in Treatment of Biliary Complications after Orthotopic Liver Transplantation

目的探讨微创治疗手段在同种异体原位肝移植术后胆道并发症的应用价值.方法回顾性总结昆明地区开展肝移植的医院1999年6月至2006年2月完成的104例同种异体原位肝移植的临床资料,13例出现胆道并发症(包括胆漏,胆道狭窄,胆道结石及胆道铸型综合征等),6例经微创胆道外科手段确诊,8例行微创方法治疗,包括内镜下胰胆管造影(ERCP)后胆管气囊扩张、胆道置支撑管1例,内镜下十二指肠乳头括约肌切开引流(EST)3例,B超下经皮置外引管流1例,经T管电子胆道镜取石冲洗2例,内镜下鼻胆管外引流(ENBD)1例.结果13例术后胆道并发症中6例经微创手段确诊,8例中6例行微创方法治愈,治愈率为75%.结论原位肝移植术后胆道并发症病因复杂,治疗相对困难,应首先考虑微创的诊断和治疗方法,重视ERCP等微创技术在此领域的应用.

Objective To assess the minimally invasive techniques in the treatment and diagnosis of bilibeing discovered biliary complications, including bile leakage, biliary stricture and stones, biliary cast syndrome and et al, 6 patients being finally diagnosed by the minimally invasive techniques, and 8 patients being treated by the minimally invasive surgery, including air pocket expanding and biliary stenting after Endoscopic retrograde cholangio -pancreatography （ERCP）, ERCP with nose bile drainage （ENBD）, flushing and removing stones by choledochoscope through T tube, endoscopic sphincterotomy （EST） guiding of B - us. Results 6 were final diagnosed in 13 cases and , bile withdrawal through the tube under the 6 were healed in 8 cases by the minimally invasive techniques in biliary complications after OLT. Conclusion Because of its availability, diagnostic accuracy, treatment efficacy and safety, the minimally invasive techniques, especially ERCP, should be used as the first - line procedure for diagnosis and treatment of biliary tract complications after OLT.