原位肝移植术后胆道狭窄的介入治疗

Interventional Management for Biliary Tract Stricture after Orthotopic Liver Transplantation

目的:探讨经T型管及其窦道和经皮肝穿刺胆道引流治疗原位肝移植术后胆道狭窄的可行性及其疗效。方法:对252例原位肝移植术后出现胆道狭窄的26例患者分别行胆道气囊扩张术、胆道引流术和胆道支架置入术。结果:3例胆道狭窄合并胆瘘患者和3例单纯吻合口狭窄患者,经气囊扩张术和胆道引流后痊愈。6例肝内外胆管多发狭窄患者,气囊反复扩张胆道狭窄段后,5例狭窄纠正而获得痊愈;1例气囊扩张治疗后出现肝内血肿,再次行肝移植。12例肝内外胆管多发狭窄合并胆泥的患者,经反复球囊导管扩张后,10例狭窄明显减轻,黄疸缓解;1例置入胆道支架,后因支架管阻塞而再次肝移植;1例治疗后狭窄仍存在,黄疸无缓解而再次肝移植。2例T型管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解。结论:经T型管及其窦道和经皮肝穿刺胆道引流是治疗原位肝移植术后胆道狭窄的良好方法。

Objective：To discuss feasibility and therapeutic effect of the interventional management through a T tube and/or hiliary tract drainage with percutaneous transhepatic puncture technique for hiliary tract complications after orthotopic liver transplantation. Methods： A retrospective review of the clinical and imaging materials of 252 post-operative orthotopic liver transplantation cases was made. Of these 252 cases,26 patients suffered from hiliary tract complications and treated with hilliary balloon dilatation, bile drainage and hiliary stenting techniques. Results：After hiliary balloon dilatation, 3 cases with hiliary tract strictures and leaks, 3 cases with simple biliary anastomosis site strictures and 5 of the 6 cases with multiple hiliary tract strictures were cured. In one of the multiple hiliary tract stricture patients, a hepatic hematoma after hiliary balloon dilatation was found and a second liver transplantation treatment was undergone. In the 12 cases with multiple hiliary tract strictures accompanied with hiliary sludge,billiard balloon dilatation technique was repeatedly performed. In 10 of the 12 cases, the strictures improved remarkably and jaundice was gone： In one of 12 cases, hiliary tract stenting procedure had been performed, however, re-transplatation of liver treatment was engaged because of stent obstruction. In the remaining 1 of the 12 cases,on account of no improvement of the strictures and relief of jaundice were revealed after the repeated procedures, re-transplantation of liver was finally treated. In 2 cases with strictures at the opening segment of the T tube, the procedure of percutaneous transhepatic puncture for bile drainage was managed. After the procedure, the strictures improved and the jaundice relieved. Conclusion：The interventional managements through T tube and/or percutaneous transhepatic puncture techniques played an effective,convenient and minimally invasive role for treating hiliary tract strictures and other biliary complications after orthotopic liver transplantation.