胆道镜下氩气刀治疗肝移植术后胆道并发症的临床应用

Clinical application of argon plasma coagulation （APC） trans-choledochoscopy in the treatment of biliary tract related complications following liver transplantation

目的 探讨胆道镜下氩气刀（APC）治疗肝移植术后胆道并发症的临床应用价值.方法 肝移植术后胆道并发症患者27例经T管窦道胆道镜或经皮经肝胆道镜（PTCS）途径使用APC治疗肝移植术后相关胆道并发症.胆管狭窄经APC凝切增生组织后配合探条扩张;胆管异物经APC凝切后清除;胆管息肉样肉芽先行肉芽组织活检,之后凝切;吻合口缝线经APC凝切后取出.结果 25例28处胆管狭窄的治疗成功率为78.6%（22/28）;7例胆管异物的清除率为85.7%（6/7）;5例胆管息肉样肉芽的病理检查结果均为良性增生或炎性肉芽,APC清除率为100%;5例胆管吻合口缝线的APC凝切取出率为100%.无APC治疗相关并发症发生.胆管狭窄术后3个月复发率为4.5%（1/22）,术后6个月累计复发率为13.6%（3/22）,均为非吻合口狭窄.胆管异物术后3个月复发率为16.7%（1/6）,术后6个月累计复发率为33.3%（2/6）.结论 胆道镜下使用APC治疗肝移植术后胆管狭窄、胆管异物、胆管息肉样肉芽和处理吻合口缝线的成功率较高.

Objective To investigate the clinical value of argon plasma coagulation （APC）trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope （PTCS）.APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% （22/28）. The clearance ratio of bile duct foreign bodies was 85. 7% （6/7）. The elimination ratio of granulation tissues was 100% （5/5）, the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% （1/22） and 13. 6% （3/22）after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% （1/6） and 33.3% （2/6） after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.