ERCP干预移植肝胆道狭窄预后的影响因素

Prognostic factors in patients undergoing endoscopic retrograde cholangiopancreatography for biliary strictures after orthotopic liver transplantation

目的:探讨肝移植术后胆道狭窄十二指肠镜逆行胰胆管造影(ERCP)及治疗干预的预后影响因素.方法:收集2003-03/2007-05院内及院外肝移植中心收治的41例肝移植术后胆道狭窄患者的临床资料,41例患者中原发性肝癌17例,肝炎后肝硬化22例,自身免疫性肝炎2例,对其临床资料进行回顾性分析.结果:ERCP干预后41例患者均发生医源性胰腺炎,治疗后痊愈;34例发生胆道感染,10例死亡,其中7例并发肾功能衰竭,3例肝衰死亡;24例吻合口狭窄术后2mo正常出院,院外带支架正常生活,6mo后支架拔除,肝功正常,随访1年中,3例再次发生吻合口狭窄;15例胆泥、胆道铸型及10例肝内胆道狭窄干预后死亡;5例存活者肝功能反复异常,迁延不愈.结论:ERCP下的介入胆道造影是诊断胆道并发症的有效方法,胆道支架引流是肝移植术后胆道狭窄的有效治疗方法之一,但肝内弥漫性胆道狭窄胆道支架引流效果差.早期诊断、及时内支架引流及有效的抗感染是影响ERCP胆道支架引流成功的重要因素.

AIM： To investigate prognostic factors in patients undergoing endoscopic retrograde cholangiopan- creatography （ERCP） for biliary strictures after orthotopic liver transplantation. METHODS： The clinical data for 41 patients who developed biliary strictures after liver transplantation from March 2003 to May 2007 were collected and retrospectively reviewed. Of all the 41 patients, 17 underwent liver transplantation for primary liver cancer, 22 for liver cirrhosis, and 2 for autoimmune hepatitis. RESULTS： All the 41 patients developed pancreatitis after ERCP intervention and recoveredafter treatment. Thirty-four patients suffered from bile duct infection, of which 10 died （seven from renal failure and three from liver failure）. Twenty-four patients developing anastomotic strictures were discharged from hospital and lived in a normal life with biliary stents for 6 mo, and only 3 of them suffered from disease recurrence at 1 year of follow-up. Fifteen patients were complicated with biliary sludge-case formation, of which 10 died from biliary strictures and 5 had a protracted course of disease with liver dysfunction. CONCLUSION： ERCP is an effective diagnostic method for biliary complications of liver transplantation. Biliary stent drainage may be one of effective measures to treat biliary complications. Early diagnosis, prompt biliary drainage and effective antibiotic therapy are vital factors to achieve successful ERCP-mediated biliary stent drainage. Biliary stent drainage is not indicated in patients with diffuse intrahepatic biliary strictures.