原位肝移植术后胆道并发症T管造影分析及其临床意义

Clinical analysis and significance of T tube cholangiography for biliary complication after orthotopic liver transplantation

目的通过对肝移植术后胆道并发症T管造影的临床分析，明确其诊断的特殊性，使诊断的思路清晰化、条理化，在此基础上果断采取治疗措施，使移植后胆道并发症得到有效的治疗，提高生存质量和生存率。方法回顾性分析14例肝移植术后出现胆道并发症的临床诊治经过，根据T管造影在肝移植术后胆道并发症不同时期、胆管结石分布特征、肝功能的变化特点，结合内窥镜观察结果，分为早、中、晚期T管造影的不同表现，胆管结石分为的3种类型：单发型、多发型、铸型，分别做以详细描述。结果依照T管造影，胆管结石分为3型：单发型、多发型、铸型；移植术后早期（3个月以内）：肝内外胆管显影淡，似柳絮感觉，无明显的结石表现的负影，胆汁混浊，有絮状物；移植术后中期（3～6个月）：飘浮的絮状物逐渐依照胆管分布凝集成固体状，可呈单发型、多发型、铸型，肝内外胆管轻度扩张，以肝内为明显，明显扩张者少见。移植术后晚期（6个月以后）：单发型、多发型、铸型均可见，肝内外胆管扩张，或肝内胆管狭窄，表现为胆管变细、僵直、枯树枝、串珠样改变，或肝内胆管消失，此时病人黄疸明显，肝功能损伤较重。其中最近的4例依据分期分型做出前瞻性诊断后，及时采用针对性治疗措施并取得显著疗效。结论T管造影在肝移植术后胆道并发症的表现有其特殊性，必须结合内镜观察才能有效指导临床。

Objective By the clinical analysis of T tube cholangiography for biliary complication after orthotopic liver transplantation, we make it clear and logic in differential diagnosis of biliary complication to promptly achieve final diagnosis and effective treatments. Methods Fourteen patients with complications after liver transplantation were diagnosed and treated, and the retrospective analysis about it was conducted. The complications were divided into three stages of the early stage, the middle stage and the later stage according to the time after liver transplantation. The hepatic function and the characteristic of the bile duct stone was observed by T tube radiography and endoscope technique. The bile duct stone after liver transplantation was divided into three kinds： single, multiple, columnar. All these were depicted in detail. Results According to T tube radiography, bile duct stone was classified into three kinds： single, multiple, columnar. In the early stage after liver transplantation （in 3 months）, bile duct looked fuzzy in the X-ray, but no sign of bile duct stone was found. The bile was feculent with flocculation the middle stage （3-6 months after liver transplantation）, the floccule in bile duct became duct stone which could be single, multiple or columnar. Bile duct （especially intraheparle bile duct） distended. In the later stage （6 months after liver transplantation）, cholangiectasis was obvious with bile duct stone which could be single, multiple or columnar. Sometimes the intraheparle bile duct stricture was found and the intrahepatic bile duct could be thin and titanic which looked like branch or string of beads. The intrahepatic bile duct even disappeared. In this stage, the hepatic function of the sick was bad and the icterus was obvious. Four cases were diagnosed early according to the kinds of stone and stage of the complication. The therapy was done in time and the outcome was very good. Conclusion We can observe the transplanted liver＇s bile duct through the T tube channels by the choledochofiberscope and treat the biliary complications conveniently. It is necessary to combine T tube cholangiography with choledochofiberscope to get more effective direction.