ERCP治疗肝移植术后胆道并发症的疗效评价

Endoscopic retrograde cholangiopancreatography in management of biliary complications after liver transplantation

目的探讨ERCP在治疗肝移植术后胆道并发症方面的作用。方法回顾性分析2004年10月至2007年10月采用ERCP治疗39例肝移植术后胆道并发症患者的临床资料。对25例胆道狭窄患者（吻合口狭窄14例，非吻合口狭窄11例）行括约肌切开、胆管扩张、鼻胆管引流和塑料内支架置放术等治疗；对6例胆漏患者行鼻胆管引流及塑料内支架置放术等治疗；对16例胆道结石和胆泥形成患者（其中合并胆道狭窄8例）行括约肌切开、鼻胆管冲洗引流及取石网篮取石等治疗。结果ERCP手术成功率为95．9％（94／98），未出现严重并发症。吻合口狭窄的ERCP治愈率为100％（14／14），非吻合口狭窄的ERCP治愈率为27．3％（3／11），胆漏的ERCP治愈率为83．3％（5／6），结道结石和胆泥形成患者的ERCP治愈率为81．3％（13／16）。结论ERCP治疗肝移植术后胆道并发症安全性较高、疗效较好、严重并发症发生率较低。

Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography （ERCP） in treatment of biliary complications after liver transplantation. Methods Data of 39 patients who underwent ERCP between January 2005 and December 2007 because of biliary complications after liver transplantation were retrospectively evaluated. Endoscopic sphincterotomy, dilatation, nasal-biliary drainage （ENBD） and stent placement were performed in 25 patients with biliary strictures （14 at anastomosis site and 11 at non-anastomosis site）. ENBD and stent placement were applied in 6 patients with biliary leakage, while endoscopic sphincterotomy, ENBD and stone extraction with baskets were performed in 16 patients with biliary stones. Procedures were repeated when necessary. Results ERCP was successfully performed at a rate of 95.9% （94/98） without any severe complications. Strictures at anastomosis site were resolved in all patients （100%, 14/14）, while for strictures at non-anastomosis site, only 27.3% （3/11） were cured. Biliary leakage was resolved in 83.3% （5/6） patients. Complete bile duct clearance was achieved in 81.3% （13/16） of the patients with biliary stones. Conclusion ERCP proves to be safe and effective in the treatment of post liver transplantation biliary complications with low incidence of severe complications.