肝移植术后缺血型胆道狭窄非手术治疗的长期疗效分析

Long-term efficacy of nonoperative treatments for ischemic biliary lesions after liver transplantation

目的 评估肝脏移植术后缺血型胆道狭窄（ischemic biliary lesions）非手术治疗的效果。方法该研究回顾分析了2000年9月至2002年6月在天津市第一中心医院行原位肝移植术的253例病例中术后发生缺血型胆道狭窄35例，给予病人首先使用球囊扩张和支架支撑（或导管引流1～6个月）等非手术治疗手段来治疗，全部病例随访5年以上，收集病例资料分析治疗效果。结果35例缺血型胆道狭窄中24例非手术治疗后有效（9例临床治愈）。治疗有效者中后来有8例出现再次狭窄，2例再次非手术治疗有效，6例无效接受再次肝移植手术。在随访8～80个月（中位数为54个月）过程中18例病人胆道情况良好。结论非手术治疗手段对于肝移植术后缺血型胆道狭窄的治疗是有效的应该作为首选。

Objective To evaluate the therapeutic efficacy of the nonoperative treatments for the management of patients with ischemic biliary lesions following liver transplantation. Methods The clinical data of 253 adult patients receiving liver transplantation from September 2000 to June 2002 were retrospectively analyzed. Thirty-five of them having ischemic biliary lesions during liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method （1-6 months）. Results The initial technical success rate was in 24 of 35 （68.5%） patients. When reviewing 8 patients, secondary nonoperative treatments were needed for treating the delayed recurrence of biliary stricture. In 2 patients, no recurrent stenosis was seen during the further follow-up after secondary nonoperative treatment. Six patients did not respond to secondary nonoperative treatment and they were treated by surgery. Eighteen of the 35 patients （51 %） showed good biliary patency for 8-80 months （mean 54 months） of follow-up. Conclusion Nonoperative treatment is an effective therapeutic alternative for the treatment of ischemic biliary lesions occurring during liver transplantation. It has a high success rate and should be considered before surgery.