经皮经肝胆道支架术在肝移植术后胆管狭窄中的应用

Application of percutaneous transhepatic biliary stents placement for post-liver transplantation biliary strictures

目的评价经皮经肝胆道支架术治疗肝移植术后胆管狭窄的疗效。方法肝移植术后胆管狭窄患者23例,其中吻合口狭窄7例,肝门区狭窄6例,多发性狭窄10例。确诊后均行经皮经肝胆道支架术。术前均给予经皮经肝胆管引流术(percutaneous transhepatic biliary drainage,PTBD),同时对狭窄部位配合球囊扩张,胆道引流持续6个月。支架选用胆道塑料支架(内涵管,18例)或金属管(5例),支架术后继续放置引流管行胆道引流1周。结果 23例患者中治愈14例(61%),复发9例(39%)。其中置入胆道内涵管18例,12例治愈(67%);置入金属支架5例,2例治愈。7例吻合口狭窄患者,6例治愈;6例肝门区狭窄患者,4例治愈;10例多发性狭窄患者,4例治愈。结论经皮经肝胆道支架术是一种治疗肝移植术后胆管狭窄的有效方法,可使大部分胆管狭窄患者脱离引流管,提高患者的生存质量。

Objective To investigate the efficacy of percutaneous transhepatie biliary stent placement on post-liver transplantation bifiary strictures. Methods Twenty-three patients with biliary strictures after liver transplantation were entered in the study, including 7 cases with anastomotie stenosis, 6 cases with stricture in hepatic hilar region and 10 cases with multiple strictures. Percutaneous transhepatic placement of biliary stents was performed after confirmed diagnosis. Before stent placement, pereutaneous transhepatie biliary drainage （PTBD） was performed in all patients. During drainage, a biliary dilation balloon was used to dilate the strictures. The biliary drainage was maintained for 6 months. The plastic stents （ 18 cases ） or metallic stents （5 cases ） were used in this study. After stent placement, biliary drainage was performed for one week to avoid stents obstruction. Results In 23 cases, 14 cases were cured （61% ） and 9 cases suffered a relapse （39 % ）. Plastic stents were applied in 18 cases and 12 cases were cured （67 % ） after treatment. Metallic stents were used in five cases and 2 cases were cured. Among 7 cases with anastomotie biliary strictures, 6 were cured. Among 6 cases with stricture in hepatic hilar region, 4 were cured. And 4 patients were cured among 10 cases with multifocal biliary strictures. Conclusion Percutaneous transhepatic biliary stent placement is an effective method to cure post-liver transplantation biliary strictures, which can help most patients with biliary strictures obviate biliary drainage and improve their life quality.