经皮经肝胆管引流术治疗肝移植相关性胆瘘

Percutanous transhepatic biliary drainage for bile duct fistula after liver transplantation

目的 探讨经皮经肝胆管引流术（PTBD）治疗肝移植（OLT）相关性胆瘘的方法 及疗效.方法 回顾性分析经PTBD治疗的7例OLT相关性胆瘘,OLT术后受体胆瘘6例,活体肝移植（LDLT）供体胆瘘1例.吻合口瘘6例（1例合并吻合口狭窄）,其中2例合并肝动脉狭窄;肝切缘小胆管残端瘘1例.引流方式采用外引流,引流管前端跨过瘘口部位,成畔固定于胆总管内.瘘口闭合、腹腔引流管无胆汁引出为治愈.结果 7例胆瘘病人PTBD引流量180～450 ml/d,经引流21～87 d（中位时间62 d）后,复查造影瘘口闭合,胆瘘治愈率为7/7.随访时间93～675 d（中位时间124 d）,4例无症状生存,2例因多器官功能不全放弃治疗,1例肝癌复发病死.1例在引流期间出现胆道感染.结论 PTBD是治疗0LT相关性胆瘘的一种安全、简便、有效的方法 .

Objective To investigate the methods and efficacy of percutaneous transhepatic biliary drainage（PTBD）for the treatment of bile duct fistula related to orthotopic liver transplantation （OLT）.Methods Seven patients（the median age was 40,from 25 to 56 years）with bile duct fistula related to OLT from January 2007 to May 2008 were analyzed retrospectively,including 6 receptors of OLT and 1 donor of living-donor liver tansplantation（LDLT）,with anastomotic bile duct fistula and peripheral duct fistula of resection surface respectively.Of the 6 OLT receptors,hepatic artery stenosis occurred in 2 cases.All the patients underwent external biliary drainage（namely,with the drain tip in a pre-leak site）.When the orificium fistulae was occluded and no bile drained from the drainage tube of abdominal cavity,the patients were diagnosed as cured.Results The mean output of the drainage tube was 350 ml/day（range 180-450 ml/day）.After PTBD for 21 to 87 days（the median time was 62 days）,the bile duct fistula was cured in all the 7 patients.During 93-675 days（the median time was 124 days）of follow-up,4 cases survived with normal level of health,2 cases gave up treatment for multiple-organ failure and 1 case died of hepatic function failure after hepatoma recurred.Biliary tract infection was occurred in 1 patient during PTBD.Conclusion PTBD could be proposed as a safe,effective and convenient method for treantment of bile duct fistula even in patients with poor general condition.