ERCP与PTC辅助介入对肝移植术后胆道并发症的治疗

ERCP and PTC assisted interventional methods in the treatment of biliary tract complication after orthotopic liver transplantation

目的探讨ERCP与PTC辅助介入方法对肝移植术后胆道并发症治疗的临床价值。方法2001年3月至2006年11月进行的肝移植45例中,术后出现胆道并发症16例,治疗方法主要包括经内窥镜逆行胆胰管造影(ERCP)或经皮肝穿刺胆管造影(PTC)辅助介入治疗。结果经ERCP及PTC行胆道球囊扩张术、内支架植入术及内、外引流术分别治疗肝移植后单纯胆瘘1例、单纯胆道狭窄11例、胆道狭窄合并肝动脉狭窄2例及胆管狭窄并胆泥形成2例。所有病例均能有效改善患者症状。结论ERCP及PTC辅助介入方法对于治疗肝移植术后胆道并发症治疗具有创伤少,安全有效,可重复性等优点,是肝移植术后胆道并发症较佳治疗方法。

Objective To investigate the clinical value of ERCP and PTC assited interventional methods in the rteatment of biliary tract complications after OLT （orthotopic livertransplantation）. Methods From March 2001 to November 2006, among 45 cases of OLT, 16 cases with postoperative complications were simple biliary fistula in 1 cases, biliary stenosis 15. Among them, simple biliary stenosis, associated with nepatic arterial stenosis and associated with biliary mud were 11,2 and 2 cases respectively. The operative methods had papilary balloon dilation, noso-biliary duct drainage, metalicstent placement, external drainage, external and internal drainage of biliary tract and intrahepatic arterial placement. All cases underwent operation under ERCO or PTC assisted intervention. Results In the course of treatment, except for 1 case was giving treatment, the curative effects on rest 15 cases were excellent and good. 1 case of pancreatitis was found after ERCP and 1 case of septicemia was found after PTC. Mentioned above 2 cases were cured by conservative treatment. All cases were followed-up from 2-31 months. The short-term and long-term efficacies were good. Conclusion ERCP and PTC assisted interventional methods have many advantages, including less trauma, safety and can repeated management for the treatment of postoperative biliary tract complications of OLT.