原位肝脏移植术后远期胆道并发症的处理

Management of long-term biliary complications after orthotopic liver transplantation

目的探讨肝移植术后远期胆道并发症的防治措施。方法回顾性研究2006年5月～2008年9月我中心90例肝移植的临床资料。结果90例肝移植患者中12例发生远期胆道并发症（13．3％），其中胆漏1例，吻合口狭窄3例，非吻合口狭窄3例（其中ABO血型不合1例），活体肝移植术后胆肠吻合口狭窄1例，胆道结石4例。1例晚期胆漏患者充分引流后治愈。吻合口狭窄患者中，1例行PTCD球囊扩张术，2例行EB．CP球囊扩张术，共有2例放置了胆道内支架，介入治疗后恢复良好。非吻合口狭窄患者中，1例实施二次肝移植后治愈，另2例行PTCD联合胆道镜治疗，1例好转，1例死亡。活体肝移植术后胆肠吻合口狭窄者行经PTCD外引流后恢复良好。合并胆道结石患者中2例胆道结石经EST取出，1例泥沙样结石经ERCP胆道冲洗加溶石治疗后治愈，1例胆道铸型结石经EST治疗效果不佳。结论肝移植术后远期胆道并发症的处置，关键在于早期诊断，明确病因，及早采用ERCP、EST、PTCD及B超引导下穿刺置管引流等个性化治疗措施可取得积极效果。

Objective To explore the management of long-term biliary complication after orthotopic liver transplantation （OLT）. Methods The clinical data of 90 patients receiving liver transplantation in our center between May 2006 and September 2008 were retrospectively analyzed. Results There were 12 cases of long-term biliary tract complications in 90 cases （ 13.3% ）. There were 1 case of biliary leak, 3 cases of anastomotic biliary stricture and 3 cases of non-anastomotic biliary stricture, 4 cases of biliary stones/sludge/casts and 1 case of eholangiojejunal stenosis. 1 ease of advanced-stage biliary leak was cured through the full drainage. Among the patients with anastomotic biliary stricture, 1 case was subjected to sacculus dilatation through PTCD and 2 cases to sacculus dilatation through ERCP. In 3 cases, biliary tract bracket was placed in 2 cases. Among the patients with non-anastomotic biliary stricture, 1 case received second liver transplantation, and other cases were subjected to PTCD in combination with choledochoscope： 1 case was cured and 1 case got worse. 1 cholangiojejunal stenosis was successfully managed by PTCD. The patients with biliary stones/sludge/casts were performed EST/biliary lavage respectively or cooperatively： 3 cured and 1 deteriorated. Conclusion The key to management of longterm biliary complications after orthotopic liver transplantation is to make an early diagnosis and therapy. Individualized treatment can obtain satisfactory curative effects.