内镜逆行胆胰管造影术处理心脏死亡器官捐献供体肝移植受体术后胆道狭窄临床分析

Endoscopic retrograde cholangiopancreatography in the treatment of biliary strictures after liver transplantation with donation after cardiac death

目的探讨内镜逆行胆胰管造影技术(ERCP)在心脏死亡器官捐献供体(DCD)肝移植术后胆道狭窄治疗中的临床应用价值。方法回顾性分析2011年9月至2014年6月接受DCD肝移植手术治疗的34例肝移植受体的临床资料。结果磁共振胰胆管造影(MRCP)作为诊断肝移植术后胆道狭窄的标准方法,34例DCD肝移植术后发生胆道狭窄8例,发生率为23.53%,其中2例为吻合口狭窄,胆道狭窄组的肝移植等待时间明显长于非胆道狭窄组[(72.5±86.0)d vs(14.4±30.1)d,U=40.0,P=0.01]。1例自行再通,7例接受ERCP胆道内支架置入均获成功,ERCP术后并发胰腺炎4例(57.14%),胆管炎1例(14.29%)和胆管炎合并肝脓肿1例(14.3%)。结论胆道狭窄是DCD肝移植术后常见并发症,MRCP是诊断肝移植术后胆道狭窄的重要非有创性检查手段,ERCP胆道内支架置入是处理肝移植术后胆道狭窄的有效治疗方式,仍需进一步观察ERCP的疗效。

Objective To explore the role of endoscopic retrograde cholangiopancreatography （ERCP） in the treatment of biliary strictures after liver transplantation with donation after cardiac death （DCD）. Methods The clinical data of thirty-four patients undergoing liver transplantation between September 2011 and June 2014 in our hospital was retrospectively analyzed. Results Magnetic resonance cholan-giopancreatography（MRCP） was the standard method for the diagnosis of biliary stricture after liver trans-plantation. The biliary stricture incidence rate after liver transplantation with DCD was 23.53% （8/34）, in-cluding two cases of anastomotic stricture, and 6 cases of non-anastomotic stricture. The waiting time for liver transplantation in the biliary stricture group was longer compared with that in the non biliary stricture group[（72.5±86.0） d vs （14.4±30.1） d, U=40.0, P=0.01]. One biliary stricture case recovered to normal without any intervention. Seven liver transplant recipients with biliary stricture were cured successfully by placing biliary tract stent through ERCP. The complications after ERCP was acute pancreatitis in 4 cases （4/7, 57.14%）, 1 case with cholangitis （1/7, 14.29%） and 1 case with combined cholangitis and hepatic ab-scess （1/7, 14.29%）. Conclusions Biliary stricture is the common complication after liver transplantation with DCD, while MRCP is an importantly noninvasive detective method for the diagnosis of biliary stricture after liver transplantation. Placing biliary tract stent through ERCP is the effective treatment for the biliary stricture after liver transplantation. Its curative effect for the biliary stricture needs further investigation.