原位肝移植术后胆管铸型综合征病因分析及处理

Pathogenic analysis and treatment of biliary cast syndrome following orthotopic liver transplantation

目的探讨原位肝移植术后胆管铸型综合征的病因及处理。方法回顾性分析1999年2月至2005年12月完成的325例次原位肝移植的临床资料。结果术后发生胆管铸型综合征6例。MRCP/ERCP诊断准确率为100%。通过内镜介入手段取出胆管内铸型物2例,再次肝移植手术4例。结论肝移植术后发生胆管铸型综合征主要与缺血-灌注损伤、胆道缺血等因素有关。胆道成像技术有助于诊断肝移植术后的胆道胆管铸型综合征。内镜治疗是首选方法,手术应在介入治疗无效后考虑。

Objective To investigate the pathogenesis of biliary cast syndrome following orthotopic liver transplantation （OLT） and explore the methods of treatment. Methods Clinical data of 325 cases of OLT performed at our institute from February 1999 to December 2005 were retrospectively analysed. Results Six patients developed biliary cast syndrome following liver transplantation. The accuracy rates of diagnosis by MRCP/ ERCP were 100%. Of all biliary complication cases, 2 cases were successfully removed cast from the bile duct by ERCP, and 4 cases received retransplantation. Conclusion The formation of biliary cast syndrome after OLT is mainly due to ischemia/reperfusion injury and bile duct ischemia. Cholangiography is helpful for diagno- sis of biliary cast syndrome. With regard to treatment, endoscopic intervention is the first option, and operation follows unsuccessful intervention.