大口径导管保留支撑治疗肝移植术后胆管吻合口狭窄疗效观察

Effect of large profile catheter maintenance in treating biliary anastomotic stricture after liver transplantation

目的 评价大口径导管保留支撑治疗肝移植术后近期胆管吻合口狭窄的疗效.方法 2009年1月至2012年12月南京医科大学第一附属医院收治的6例肝移植术后胆管吻合口狭窄引起梗阻性黄疸患者.胆管吻合口狭窄发生在肝移植术后1个月内4例,1个月以上2例.对肝移植术后1个月内发病的患者,先给予经皮经肝胆道引流术（percutaneous transhepatic cholangial drainage,PTCD）引流,待患者的血清总胆红素迅速下降接近正常范围,然后采用大口径导管保留支撑的方法引流.肝移植术后1个月以上发病的患者PTCD后直接采用大口径导管保留支撑的方法引流.随访并观察6例患者的疗效.结果 6例肝移植术后胆管吻合口狭窄患者均成功使用10～14 F导管保留支撑的方法治愈.术前血清总胆红素中位数135 μmol/L,治疗后1个月内下降至中位数48 μmol/L,导管保留支撑的时间4～10个月.6例患者引流管撤除后随访3～10个月,患者均未出现黄疸症状复发.2例支撑导管保留时间较长者,治疗过程中导管周围出现胆汁渗漏和皮肤感染,给予对症处理后症状消失.结论 大口径导管保留支撑是治疗肝移植术后胆管吻合口狭窄的安全而简便的方法.

Objective To evaluate the effect of large profile catheter maintenance in treating early biliary anastomotic stricture after liver transplantation （LT）. Methods Six patients with obstructive jaundice caused by biliary anastomotie stricture after LT were enrolled in the First Affiliated Hospital of Nanjing Medical University from January 2009 to December 2012. Four patients suffered from the biliary anastomotic stricture within one month after LT, while 2 cases over one month after LT. For the patients with biliary anastomotic stricture occurred within one month after LT, percutaneous transhepatic cholangial drainage （PTCD） was performed. Until the level of the patient＇s serum total bilirubin decreased rapidly to normal range, the large profile catheter maintenance was catried out to drain the fluid. For patients developed stricture over one month after LT, the large profile catheter maintenance was directly used to drain fluid after PTCD. Six patients were followed up, and their curative effects were observed. Results In all Six patients, the biliary anastomotic stricture were treated successfully with 10 F to 14 F catheter maintenance. The median of the level of preoperative serum total bilirubin was 135 μmol/L and it decreased to a median of 48 μmol/L within 1 month after treatments. The catheter maintenance time for retention was 4 to 6 months. Six patients were followed up for 3 to 10 months after removal of the drainage tubes. There was no recurrence of jaundice observed in all patients. The two patients with longer retention time time of catheter maintenance suffered from bile leakage and skin infections and the symptom disappeared after symptomatic treatments. Conclusions Large profile catheter maintenance is a safe and simple method in treating biliary anastomotic stricture after LT.