双引流管技术在四例肝移植术后胆道狭窄中的应用

The clinical application of double-tube drainage technique in treating biliary tract stricture occurred after orthotopic liver transplantation:report of 4 cases

目的探讨双引流管技术在治疗肝移植术后胆道狭窄中的应用价值。方法回顾性分析采用双引流管技术治疗4例肝移植术后胆道狭窄病例的资料。采用经皮经肝穿刺胆道引流介入技术,建立1～2条引流道置入双引流管。结果 4例胆道并发症均患者表现为肝内胆管和胆总管多发狭窄合并胆泥形成。患者平均年龄55岁,供肝冷缺血时间11.4 h、热缺血时间6 min。胆管重建方式均为胆总管端端吻合。双引流管自同一引流通道和2条引流道置入者各2例。4例分别行球囊扩张成形及引流术3、9、11、35次。1例治疗后无效,3例好转。结论双引流管技术可选择性应用于吻合口和非吻合口多发胆道狭窄且胆泥形成的病例,反复的胆道塑形和充分引流,为有效的治疗方法。

Objective To discuss the clinical value of double-tube drainage with the help of percutaneous transhepatic puncture technique in treating biliary tract stricture which occurred after orthotopic liver transplantation.Methods Double-tube drainage management was carried out in four patients with biliary tract stricture which occurred after orthotopic liver transplantation.With the help of percutaneous transhepatic puncture technique one or two tunnels were established,via which two tubes were inserted and double-tube drainage was performed.The clinical data were retrospectively analyzed.Results All the four patients were suffered from multiple biliary tract strictures accompanied with biliary sludge.The mean age,the cold ischemia time and warm ischemia time of grafting liver were 55 year,11.4 hours and 6 minutes,respectively.Biliary reconstruction was accomplished by end-to-end anastomosis of the bile ducts.The two drainage tubes were inserted through one tunnel in two cases and through two tunnels in another two cases.In the four cases the biliary balloon dilatation and bile drainage were respectively performed 3,9,11 and 35 times.Good clinical result was obtained in three cases and ineffective result was seen in one case.Conclusion The double-tube drainage technique can be selectively applied in the patients with multiple biliary tract strictures and biliary sludge.Repeated biliary plasty and thoroughly drainage are the keys to ensure an effective treatment of biliary stricture occurred after orthotopic liver transplantation.