肝移植术后胆道并发症的内镜治疗

Endoscopic retrograde cholangiopancreatography for biliary complications after liver transplantation

目的:探讨内镜下逆行胰胆管造影术(ERCP)在治疗肝移植术后胆道并发症方面的临床疗效。方法:回顾性分析2002年8月—2012年12月采用ERCP治疗8例肝移植术后胆道并发症患者的临床资料,其中胆道狭窄5例(吻合口狭窄4例,肝内型胆道狭窄1例),胆瘘1例,胆石和胆泥形成2例。8例患者共行ERCP治疗21次,对胆道狭窄患者行括约肌切开、胆管扩张、鼻胆管引流和内支架置放术等治疗;对胆瘘患者行鼻胆管引流及塑料内支架置放术等治疗;对结石患者行括约肌切开、鼻胆管冲洗引流术及取石网篮取石等治疗。结果:ERCP手术成功率为100%(21/21);4例吻合口狭窄、1例胆瘘和2例结石患者均治愈,1例肝内型胆道狭窄治疗未成功,建议再次肝移植;术后胆道感染的发生率为14.3%(3/21),胰腺炎发生率为19.0%(4/21),经对症治疗后均痊愈。结论:ERCP是治疗肝移植术后胆道并发症微创、安全和有效的方法。

Objective： To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography（ERCP） in management of biliary complications after liver transplantation. Methods： The clinical data of 8 patients undergoing ERCP for biliary complications after liver transplantation between August 2002 and December 2012 were retrospectively analyzed.Of the patients,5 cases had biliary stricture（4 cases of anastomotic biliary stricture and one case of intrahepatic biliary stricture）,one case had developed bile leakage,and 2 cases had biliary calculi and biliary sludge.ERCP was performed 21 times in the 8 patients,and was combined with endoscopic sphincterotomy,dilation of the bile duct,nasobiliary drainage and stent placement for those with biliary stricture,with endoscopic nasobiliary drainage and placement of plastic stent for the one with bile leakage,and with endoscopic sphincterotomy,nasobiliary drainage and stone extraction via basket for the two cases with bile duct stones. Results： ERCP was successfully carried out 21 times（100% success rate）.The 4 patients with anastomotic biliary stricture,one patient with bile leakage and 2 patients with bile duct stones were all cured after ERCP,but there was one treatment failure in the patient with intrahepatic biliary stricture,for whom a second liver transplantation was recommended.The incidence of biliary tract infection and pancreatitis after ERCP was 14.3%（3/21） and 19.0%（4/21） respectively,which were all resolved after symptomatic treatments. Conclusion： ERCP is a minimally invasive,safe and effective treatment modality for biliary complications following liver transplantation.