管腔内介入技术治疗肝移植术后胆管吻合口狭窄

Application of intraluminal interventional technique in treatment of bile duct anastomotic strictures after liver transplantation

目的探讨管腔内介入治疗技术在肝移植术后胆管并发症治疗中的价值。方法应用管腔内介入治疗技术对9例肝移植术后胆管吻合口狭窄（1例伴胆汁瘘）的病人进行治疗，其中4例胆管明显扩张、胆汁淤积者先行经皮胆管引流术。9例中2例单纯行球囊扩张成形术，7例反复球囊扩张无效者行胆道支架置入术。术后利用临床、化验及影像学手段进行观察与随访。结果所有行管腔内介入技术治疗的病例均获成功，未出现与治疗相关的并发症。所有病例术后临床症状均有明显好转，胆红素在1个月内全部降至正常，肝内外胆管扩张明显减轻，胆汁瘘在支架置入术后1个月后消失。随访期间1例于支架置入术3个月后死于肿瘤复发，其余病人均健在，未出现与管腔内治疗相关并发症，均未出现再次黄疸，影像学检查显示无胆管扩张，支架通常。结论管腔内介入技术治疗肝移植术后胆管吻合口狭窄疗效确切，并发症少，应在外科术前首先考虑。

Objective To evaluate the application of intraluminal interventional technique in the treatment of bile duct anastomotic strictures after liver transplantation. Methods Nine cases of bile duct anastomotic strictures （1 was accompanied by bile leak） after liver transplantation accepted intraluminal interventional treatment. Percutaneous transhepatic vholangiography drainage was used in 4 cases with markedly dilated bile ducts. Of the 9 cases, 2 were treated with balloon catheter dilatation and 7 with expandable metallic stent implantation after noneffective balloon dilatation. All the 9 cases were observed and followed up with clinical, laboratory and imaging measures. Results Technical success was achieved in all the 9 cases and no therapeutic complications occurred. Clinical symptoms returned remarkably and serum bile decreased to normal. Bile duct dilatation alleviated and bile leak were healed 1 month after stent implantation. Within the follow-up period, 1 case died of recurrent hepatic carcinoma and other cases were all alive. No therapeutic complications occurred. No jaundice and dilated bile ducts appeared. All stents kept patency. Conclusion Intraluminal interventional technique in the treatment of bile duct anastomotic strictures after liver transplantation is effective and safe and should be used before surgical revision or retransplantation.